Senate advances competing Medicaid alternatives


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Community leaders, residents and South Florida members of the Service Employees International Union (1199SEIU) members plan to gather Thursday night, beginning at 6 p.m. at San Jacinto Park, 4450 SW 15th Street, Coral Gables to call on state Rep. Erik Fresen, R-Miami, and the Florida Legislature to accept federal funding and expand Medicaid healthcare coverage to more than 1 million Floridians.

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A Senate panel on Wednesday passed two very different proposals to expand health insurance for low-income Floridians under the federal health law, leaving billions of federal dollars at stake.

With less than three weeks left in the Legislative session, lawmakers in the House and Senate are still worlds apart on whether to accept an estimated $55 billion dollars from the feds over the next decade to offer health coverage to roughly 1.1 million residents or to rely on state funds to cover only about 115,000 residents.

House leaders have adamantly spoken out against accepting federal money tied to the Affordable Care Act, leaving Senate lawmakers scrambling to craft a proposal they will agree to. Both chambers voted against a straight Medicaid expansion early in the session.

But, so far, instead of endorsing just one plan, the Senate is keeping alive two different options depending on how negotiations go in the final days of the session. That irritated some senators.

"I’m concerned we may send a mixed message if we send two bills out of here. It’s like trying to take two dates to the prom...I think we need to be very careful that we don’t show any reluctance with that and we need a total resolve to move forward with that plan....and I’d hate to send the wrong message that we might be having second thoughts," said Sen. Bill Montford, D-Tallahassee.

But Sen. Aaron Bean, whose less comprehensive plan would pass up federal dollars, urged committee members to support both proposals to give lawmakers options, arguing his bill may be the only path the House is willing to consider.

"There’s another body across the way that also has a say in what we do. They haven’t shown an interest in taking federal funds," said Bean, R-Fernandina Beach.

A plan by Sen. Joe Negron unanimously passed the committee and received rare support from the business community, labor advocates and healthcare providers during public testimony.

The plan “meets the goals that our board has set, which is providing additional access, availability, affordability and quality care to Floridians, as well as at least alleviating those additional costs on our businesses,” said Tammy Perdue, general counsel for the influential business lobby Associated Industries of Florida.

Gov. Rick Scott has also expressed support for Negron’s proposal, warning that bypassing federal dollars and paying for health coverage with state funds would put a double burden on Florida taxpayers. Negron’s plan would give the federal money to recipients in the form of vouchers that would allow them to choose a private insurance plan.

A bill that mirrors Bean’s passed a House committee on Monday, while that same committee shot down a plan similar to Negron’s.

The House plan would use $237 million in state funds to give recipients $2,000 a year to choose their own private insurance plans through the Florida Health Choices program. The Obama administration has sought to offer health insurance to more Americans by extending the Medicaid eligibility levels to those making up to 138 percent of the poverty level, but Bean’s plan and the one in the House only addresses residents making at or below 100 percent or roughly $11,000 a year for a single person and about $19,500 for family of three

The Senate bills, which both require recipients to pay premiums and co-pays, still have another stop at the full Appropriations Committee led by Negron.

"I know it’s not perfect and I know it’s not as big or luxurious as some may want it, but the way we designed this plan we covered the basics first," said Bean, who noted that over time lawmakers could add additional money, increase benefits or cover more people.

Bean’s proposal passed along party lines Wednesday with much less enthusiasm than Negron’s plan, and several Democrats criticized it for falling far short of offering any comprehensive solution.

“As we see all the different proposals, I think this is truly the most responsible use of our taxpayer dollars,” said Sen. Rene Garcia, R-Hialeah.

"It seems on its face to be cheaper, but that’s because it doesn’t do much of anything. I liken the bill to buying four flat tires and expecting the car to drive. I don’t think this bill drives us to where we need to be," said Democratic Sen. Audrey Gibson of Jacksonville.

Negron, R-Stuart, said he’s optimistic the House and Senate can take the best of both proposals. He suggested a hybrid bill that would allow recipients to choose between a health insurance voucher or to take that same amount of money and put it toward a basic health insurance plan. If lawmakers did decide to take federal money, it would allow them to put "substantially" more than the proposed $2,000 a year toward each health plan, he said.

House Republicans are mulling a third proposal that would cover about 130,000 people and be paid for without federal money. That plan, shepherded by Rep. Richard Corcoran, R-Land O’Lakes, would cost the state as much as $266 million annually.

Negron said Wednesday he is willing to work with House Republicans on a compromise that would contain elements of each plan.

The Obama administration will pay 100 percent of the federal health program for the first three years and 90 percent after that, but Republicans are concerned the federal government will back out of the promise, leaving the state on the hook.

"The issue on the federal funds is an important issue to our friends in the House and it’s an important issue to me...Rather than having it’s all or nothing, let’s acknowledge the fact that there are some good uses for federal funds and I believe using some federal funds for [the House] plan would be a potential negotiation resolution."

Gov. Rick Scott, a fierce critic at one time of the federal healthcare overhaul, continued to insist that state lawmakers "will do the right thing" now that the overhaul was the "law of the land."

"What I’ve said all along is I will support a bill that while the federal government pays 100 percent we increase access to those who can’t afford it," Scott said Wednesday. "...Right now what the Senate is proposing fits in with what I’ve been talking about."

Herald/Times Tallahassee reporter Tia Mitchell contributed to this report.

Tia Mitchell can be reached at tmitchell@tampabay.com.

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