The long legal battle over the Patient Protection and Affordable Care Act (ACA) is finally over. A Supreme Court majority, led by Chief Justice Roberts, upheld the constitutionality of the new law, often known simply as “Obamacare.” However much some wish to repeal or replace ACA, it is the law of the land. We now have the responsibility to implement it.
Florida Gov. Rick Scott has foolishly put partisanship before pragmatic governance by stating his intention to reject key opportunities available under the new law. The ACA allows Florida to expand Medicaid to cover individuals who earn less than roughly $15,000 a year and families of four earning less than about $31,000. This translates to about $20 billion in federal Medicaid funds to cover as many as 1.8 million Floridians who will otherwise go uninsured.
The federal government will cover the entire cost of this expansion until 2017, and gradually will phase down to 90 percent coverage of the costs after 2020. Over time, these costs would average out so that the federal government’s contribution would equal roughly $19 for every $1 Florida would spend on expanded Medicaid coverage.
Even that 19-1 ratio understates the economic value of this program to Florida. Most of the Medicaid expansion funds would be used to pay doctors, safety-net hospitals, home healthcare agencies and nursing homes that already provide these services in the form of uncompensated care or through state- or county-funded programs to assist needy individuals.
Jackson Memorial Hospital, Miami-Dade’s most prominent provider of safety-net care, underscores both the great need for increased Medicaid funding and the great benefit these funds would bring in improving both access and quality of care for greater Miami. In 2011, Jackson was badly hurt by a $110 million state cut in Medicaid, which necessitated extensive layoffs and employee furloughs.
During that year, much of Jackson’s $450 million in uncompensated care was provided to low-income patients who would gain health coverage if Florida agreed to expand Medicaid under the ACA. Jackson CEO Carlos Migoya noted that the Medicaid expansion would bring a “dramatic improvement to our finances.” Again, roughly 95 percent of these costs would be borne by the federal government. From either an economic or a public-health perspective, this is not a tough call.
The governor has defended his harsh stance on the ACA through an odd string of misleading statements regarding the health-reform law. He falsely stated that ACA’s Medicaid expansion would cost Florida “$1.9 billion a year,” overstating Florida’s obligations by at least 300 percent, while failing to note that most of these costs don’t arise until 2020. He falsely stated that a small firm with 20 employees could go out of business because of requirements imposed under the new law. In fact such firms are exempted.
The governor crudely stoked public fears by asserting that the ACA will ration care, as allegedly occurs in Canada or Great Britain. The nonpartisan website politifact.com labeled each of the governor’s claims “False,” or “Pants on Fire.” It’s hard to recall another leading official so consistently misinforming the public regarding critical issues of state policy.
Now that the court has spoken, it’s time for Scott, state legislators, medical providers and the Obama administration to cooperate in a spirit of goodwill to implement the new law. Florida has the chance to meet widespread human need, and to infuse our state with billions of dollars that would otherwise be lost. Let’s get to work.
Margaret M. Byrne and Kathryn E McCollister are professors at the Department of Epidemiology and Public Health, University of Miami medical school. Harold Pollack is a professor of social service administration at the University of Chicago.