Expanding Medicaid makes economic sense


Last month, Gov. Rick Scott announced that he was going to take the federal government up on its offer to cover the cost of Medicaid expansion in Florida. His decision would give health coverage to as many as 1.2 million additional low-income Floridians.

Here’s how it would work: Starting in 2014, people who make less than 138 percent of poverty, or about $15,000 a year, will be able to receive health insurance through Medicaid — coverage that they currently do not have access to in our state. For the first three years, the federal government will cover the cost of care for these new enrollees.

But last week, the Florida House of Representatives came out against Scott’s decision, saying that expanding Medicaid will cause costs to go up and care to deteriorate. Then this week, a committee in the Florida Senate rejected the Medicaid expansion that the governor proposed.

It’s clear that the Legislature has left the door open for an alternative that would privatize Medicaid. But by some estimates that would be way more expensive than simply expanding Medicaid. More specifically, the independent Congressional Budget Office estimates the cost of private insurance to be 50 percent more than Medicaid.

In fact, I would argue that the stakes are too high and the cost is too great to not expand the program in the Sunshine State. Here’s why:

Right now, Florida taxpayers are spending money to treat uninsured children, disabled and elderly folks when they get sick. When uninsured patients go to the emergency room for uncoordinated and often incredibly expensive care, a lot of hospital bills go unpaid. The state then steps in so that hospitals can keep their doors open — and Florida taxpayers are left picking up the tab.

If Florida agrees to expand Medicaid, people won’t have to wait until a cold becomes pneumonia or high blood pressure becomes a heart attack. They can see a primary-care physician to help keep diabetes under control or learn about what causes an asthma attack to prevent the next one.

Providing the poor with health coverage for the care they need up front is a smarter way to use money. And, it’ll free up funds that were going toward hospital bills for other priorities like education or infrastructure.

It’s also important to note that if Florida doesn’t take the money that the federal government is offering, then other states will. This happened when the governor rejected billions of dollars for high-speed rail. Across the country, states are expanding Medicaid, and another state will take the money that’s been set aside for the Sunshine State. Scott pointed out that healthcare reform — which called for Medicaid expansion — is now the law. So, if we’re already paying for it, shouldn’t we reap the savings from smarter care?

In the private-insurance market, subsidies designed to make insurance affordable are among the major benefits of healthcare reform. The subsidies are scheduled to start in 2014 and will available in every state — including Florida.

But if Florida turns down the money, those with incomes below 100 percent of poverty will not get assistance so they can afford the health insurance. They will not get help, while many people with higher incomes will still get assistance paying for coverage. We’ll be in the same place we are now — spending more for worse coverage because people don’t have any other option.

In his announcement last month, Gov. Scott said he could not “in good conscience deny the uninsured access to care.” I urge the Legislature to support his decision. How can state lawmakers possibly rationalize their decision not to do so?

The Legislature should not miss this opportunity to take advantage of a health-care investment that will reap benefits for all Floridians.

Bill Nelson, Florida U.S. senator, Washington, D.C.

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