Gov. Rick Scott’s oh-so-quick dismissal of the opportunity to provide healthcare to more Floridians under Medicaid, which came just one day after the Supreme Court decision upholding most of the Affordable Care Act, should not be the last word on the subject.
His decision was politically inspired, and his facts have been called into question. For Floridians desperate to get basic healthcare the consequences could be dire. Train wreck, perfect storm, falling off the cliff — all of these phrases have been used to describe the impact of Mr. Scott’s decision unless the Legislature takes a more thoughtful approach.
The law upheld by the court expands Medicaid to cover those at or under 133 percent of the federal poverty level. Currently, Florida has a much stricter threshold. (The undocumented are not covered under any scenario.)
The court held that states could not be punished if they opted out of expanded coverage, but there’s a catch: The law also mandates some $18 billion in Medicaid payment cuts nationwide. That was written into the bill on the assumption they’d be offset by a lower burden of caring for the uninsured.
If Florida continues to ignore the “working poor” who can’t afford health insurance, these patients will have no recourse except to continue relying on public hospitals for unreimbursed care.
But they will do so without the increased funding that the new law guarantees as compensation for the states, placing the burden on local taxpayers.
Officials at the Jackson Health System are wary. They get $350 million in a special Medicaid appropriation from the Low Income Pool, far more than any other hospital in the state. They worry that if those funds are redistributed by Congress to cover Medicaid expansion nationwide, they could lose more than they gain in federal funds for new Medicaid patients.
But in terms of providing better healthcare, the Medicaid expansion, frankly, is a no-brainer.
The National Association of Public Hospitals estimates that about 4 million people who would have been eligible for Medicaid could go uninsured in states that have decided against expansion. In Florida, the move would expand coverage to an estimated one million more adults and children. Rejecting expansion will worsen the problem of uncompensated care in Florida, which already has the third highest percentage of uninsured patients in the country.
According to Politifact, Mr. Scott got a number of things wrong in rejecting expansion. Among other things, he said wider Medicaid coverage would cost the state an additional $1.9 billion a year. He repeated the figure at least four times, but Politifact said the estimate was “wildly high” and rated his overall claim “false.”
Under the plan, the federal government would fund the first three years of expansion at 100 percent, but Florida would begin paying a small share after that, rising to 10 percent in 2020 and beyond.
Mr. Scott doesn’t like what he derisively calls “Obamacare,” but if he has a case to make, he should rely on better numbers. From 2014 to 2019, the Kaiser Commission on Medicaid and the Uninsured estimates Florida could get up to $24 billion from Medicaid expansion — at a cost of $2.5 billion in matching state funds.
Agreed — any demand for more Medicaid funding could pose a serious financial problem for Florida down the road. But the Legislature owes it to the state’s residents, especially the uninsured, to undertake a serious cost/benefit analysis, using real numbers, instead of taking a political approach.