Florida spends about $4,168 per Medicaid patient, less than the U.S. average of $5,535, according to the Henry J. Kaiser Family Foundation, a leader in health policy analysis. Only three states spend less per Medicaid enrollee — California, Georgia and Alabama.
Under the Affordable Care Act, the Medicaid expansion would allow more than 1 million of Florida’s uninsured to qualify for coverage, by raising the income limit for many programs to 133 percent of the Federal Poverty Level, or about $30,000 for a family of four.
Right now, some populations — including young adults and parents — must make no more than 22 percent of the Federal Poverty Level to qualify for coverage. That’s $2,457 a year for an individual or $5,071 for a family for four.
Those restrictions have contributed to Florida having the third-highest rate of uninsured residents in the country, said Joan Alker, co-executive director at the Georgetown Public Policy Institute, who has studied Medicaid for years.
But now, “Florida stands to benefit more than most states from the Medicaid expansion because your program has been ungenerous,” Alker said.
Without coverage, many of the state’s 3.8 million uninsured residents often forego needed care or seek care in hospital emergency rooms.
“That’s the most expensive form of care,” said Jay Wolfson, a health policy expert at the University of South Florida.
And when they leave with hefty bills they can’t pay, hospitals end up absorbing large amounts of uncompensated, or “charity” care, which experts say affects Floridians in several ways.
To recoup those costs, hospitals either reduce services or charge higher rates to insurance companies, or both. Those costs are often passed down to businesses that provide insurance for their employees.
“And that is going to end up in your premiums,” said Rueben, of the Florida Hospital Association.
Many refer to this as a “hidden tax.” Families USA, a nonprofit group based in Washington, D.C., that advocates for quality, affordable health care, estimated that the “hidden tax” added an extra $1,017 to annual family health insurance premiums in 2008, and an additional $368 in individual premiums.
But the arguments for Medicaid expansion go beyond dollars and cents.
“We know from all research that people with insurance tend to be healthier than those” without, Rueben said. “It’s not a good thing if they have that opportunity, but it is denied them.”
In a recent national poll by the Kaiser Family Foundation, people who had personally been enrolled in Medicaid said overwhelmingly that their experiences with the program were positive.
Rueben and others say Medicaid would give more people access to preventive services such as checkups and screenings and to prescription medications needed to manage chronic illnesses such as diabetes and heart disease.
“When people wait to come to the ER, it’s not just a matter of the expensive use of the ER,” he said. “They’re usually sicker, they’ve waited longer, and their chances for positive outcomes are reduced.”
But even those who support the expansion acknowledge the governor’s concerns and Medicaid’s limitations.
Medicaid now makes up almost a third of the entire state budget. Health providers have long complained that Medicaid reimbursements are so low they don’t cover the costs of care. And because of low reimbursements, fewer physicians in the state actually accept new Medicaid patients.