When the recent landmark decision by the Supreme Court upheld the legality of the Patient Protection and Affordable Care Act (ACA), several major reforms of healthcare policy and practice were assured, and one huge controversy was sparked. Some key provisions of the law apply with special significance to Florida’s children:
• Protections against excluding individuals with pre-existing conditions (at least 400,000 in Florida) from obtaining full benefits of health insurance coverage.
• Offering preventive services recommended by the American Academy of Pediatrics Bright Futures Guidelines at no cost to families.
• Increasing Medicaid payment rates to Medicare levels for 2013 and 2014, improving the capacity and readiness of healthcare providers to treat children.
• Extending permission for dependent children to remain on their parent’s health insurance policy until age 26 (224,000 in Florida).
• Approving the expansion of Medicaid to one million more children and adults in Florida whose families earn incomes at or below 133 percent of the federal poverty level ($25,390 for a family of three in 2012).
That last mentioned change has already stirred enormous political debate within Florida since the Supreme Court also ruled that states may decide not to expand their Medicaid programs to all citizens who meet income eligibility and would not have to pay the financial penalties that the ACA originally demanded.
Of course, if Florida does not to expand its Medicaid coverage, $20 billion in federal funds will be diverted from Florida to other states over the next ten years. This is money paid by Floridians through federal income taxes that will go to residents of other states if our state government rejects Medicaid expansion.
Over two million children in Florida participate in Medicaid or the Child Health Insurance Program (CHIP) also known as Florida KidCare. The vast majority of individuals enrolled in and benefitting from Florida’s Medicaid program are children from families who work at low-income jobs.
How much would it cost our state to expand health insurance coverage to low-income children and families, children with disabilities and children with serious chronic health problems?
First of all, the federal government will pay all of the cost of expansion through 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent in 2020 and beyond. Currently, the federal government puts up only 58.72 percent of the Medicaid match dollars. So Florida will spend $214 million per year, of which less than $130 million is expected to come from general revenue that the state is directly responsible for raising. Putting this into context, providing the security of health insurance to over a million more children and families through Medicaid expansion can be expected to increase total state spending for Medicaid by only 1.8 percent through 2022-2023.
The Florida Center for Fiscal and Economic Policy, an independent policy research organization, calculates that after factoring in reductions associated with the delivery of uncompensated medical care to the formerly uninsured, Florida taxpayers should see a net savings as a result of Medicaid expansion. Each dollar of expansion-related state spending over the next ten years will leverage an additional $9.51 in federal funding, stimulating our regional economy and creating an estimated 65,000 private-sector jobs in the first six years alone.
If Florida refuses to participate in the Medicaid expansion part of the ACA healthcare law, taxpayers will have to pay more and private health insurance premiums will rise to cover the cost of uncompensated care. Business owners and hospitals will experience back-breaking financial burdens for having to subsidize the care of uninsured and underinsured children and parents.
Our children will suffer the highest personal toll - limited prospects for health, reduced ability to learn and succeed in school or work and, ultimately, the failure to contribute to the economic recovery, prosperity and civic leadership of our state and nation.
We may choose to permanently expand the current economic recession by keeping the vulnerable among us vulnerable. Or we can recognize that everyone comes out ahead if we collectively support the right and the opportunity for all children to achieve their potential.
Dr. Peter A. Gorski, M.P.A., is the chief health and child development officer of The Children’s Trust and professor of public health, pediatrics and psychiatry at the University of South Florida.