Medicaid-expansion alternative more costly


As state after state has signed on to the Medicaid expansion offered under the federal Affordable Care Act (ACA), Florida Republican legislators have dug in their heels.

First, the Florida House, then the Florida Senate Select Committee voted to reject Medicaid expansion. While committee chair Sen. Joe Negron said that he had an alternative to the federal plan, it appears that, even though he has had months to formulate one, he did not have any details to present at the panel’s hearings.

Under the ACA, Medicaid expansion would provide medical coverage to almost 1 million Floridians. Many, if not most, are working. Their incomes are just above current Medicaid income limit, and their employers do not provide them medical coverage. This would bring in more than $50 billion to Florida over the next 10 years and provide critical healthcare to needy Floridians. The federal government with support 100 percent of the program for the first three years and 90 percent thereafter.

Members of the Senate Select Committee claimed that Medicaid is a broken program, but they did not present a single piece of supporting evidence. Several days after the Senate Select Committee hearings, Negron did present an alternative plan that would essentially expand the current Florida KidCare program, which offers low-cost health-insurance plans for eligible children.

These plans are offered through private health-insurance companies. The overhead costs are reported to be between about 18 percent and 23 percent. The overhead costs of Medicaid, depending on how it is calculated, is only a small fraction of the overhead costs of private health-insurance companies. In addition, according to the Henry J. Kaiser Family Foundation Commission on Medicaid and the Uninsured, at 6.1 percent, per-enrollee cost growth in Medicaid is lower than that of under Medicare (6.9), private health insurance (10.6) and monthly premiums for employer-sponsored insurance (12.6).

The program that Negron has proposed would allow the private, participating health-insurance companies to charge up to 15 percent overhead, much higher than that of Medicaid, and would allow for the per-enrollee cost growth of up to 12.6 percent. His proposal will reduce the funding available for patient care while increasing the profits of the participating private health insurance companies. That does not appear to be responsible or consistent with using taxpayer dollars in the most efficient manner possible. It only funnels 15 percent of the more than $50 billion that Florida would receive for Medicaid expansion — $7.5 billion — to private health-insurance companies and, I assume, their lobbyists. Something is not right here, and the public should be outraged.

Paul C. Hunt, South Miami

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