TALLAHASSEE -- Two House Republicans unwittingly revived hopes this month that lawmakers could compromise on a proposal to expand Medicaid.
“Lawmakers say Medicaid expansion not dead,” read the headline in the Sarasota Herald-Tribune, highlighting comments from Manatee County Reps. Greg Steube and Jim Boyd.
But the reality is no different today than it was when the legislative session ended:
Medicaid expansion, or some alternative, remains a long shot.
“All I was simply trying to say was, we all agree it’s an important issue,” Boyd told the Herald/Times about his remarks at a June 6 luncheon. “We thought we had a pretty good plan.”
That plan, championed by House Speaker Will Weatherford, included saying no to $51 billion in federal money over 10 years. Instead, House Republicans proposed using up to $300 million in state funding to subsidize basic coverages for about 130,000 people.
The Senate and Gov. Rick Scott rejected the idea out-of-hand, just as House Republicans swatted away any attempt to include federal money to expand health care to 1 million or more Floridians.
Both Boyd and Steube told constituents they would be open to a special session to try to reach some agreement. But several House members told the Herald/Times that is unlikely unless Weatherford, R-Wesley Chapel, hears an offer he likes.
House leaders insist it’s the federal government, not they, that needs to bend. They want the U.S. Department of Health and Human Services to approve plans that qualify for some, but not all, of the Medicaid expansion funding. In particular, House Republicans are hesitant to provide subsidized health care to childless adults.
“I think they need to give the states more flexibility,” said Rep. Richard Corcoran, R-Land O’ Lakes, a top-Weatherford ally who crafted the House plan.
While Florida lawmakers remain at a stand still, other states are pushing forward with Medicaid expansion. In Arizona on Thursday, a coalition of moderate Republicans joined Democrats to extend coverage to 350,000 low-income residents.
There, the issue was resolved only after Gov. Jan Brewer, a Republican who once opposed the health care law, called the Legislature into special session. She did so without the blessing of Republican leaders but after she became concerned that the regular session would end without an agreement.
Twenty-three states and the District of Columbia are moving forward with Medicaid expansion, according to the Kaiser Family Foundation, while Florida is among 20 that are not. The remaining seven are undecided.
Rep. Mike Fasano, R-New Port Richey, is the only House Republican to publicly support using the $51 billion from the federal government to expand Medicaid. He said he thinks the Legislature will eventually reach an agreement, but, “It’s not going to happen anytime soon.”
“I believe that when business people start hearing this, the local chambers of commerce and other business groups, I think the pressure will start to build,” Fasano said. A provision in the law requires businesses to provide health care to some employees who may have qualified for Medicaid, or face steep fines.
Although Florida has not expanded Medicaid, it is moving forward with a massive overhaul of the existing program.
On Friday, the state received the waiver it needed from the federal government to transfer 3 million Medicaid participants to private managed care companies. Lawmakers hope this will help reduce program costs.
The decision was not a surprise: Federal officials signaled earlier this year that they would grant approval. Also, the Obama administration had already signed off on requiring managed care for tens of thousands of Florida seniors who need Medicaid-funded long-term care.
“Florida is leading the nation in improving cost, quality and access in the Medicaid program,'' Scott said in a statement. "CMS’s final approval of our Medicaid managed care waiver is a huge win for Florida families because it will improve the coordination of care throughout the Medicaid system. Health-care providers can now more effectively manage chronic conditions and work with families to provide preventative treatments."
Florida CHAIN, a patient-advocacy group that has been among the most-vocal critics of the managed-care requirement, issued a news release that said the federal government had included safeguards that will help protect beneficiaries. Among those safeguards: HMOs will have to spend at least 85 percent of the money they receive on patient care, a concept known in the insurance industry as a "medical loss ratio."
But Florida CHAIN also said patients and advocates will have to remain "vigilant" and pointed, in part, to controversies about a Medicaid managed-care pilot program that began in 2006 and 2007 in Broward, Duval, Clay, Baker and Nassau counties.
“Despite these federal safeguards, the focus now shifts to the state and its efforts to implement this program that will affect access to care for millions of patients in all 67 counties,'' Florida CHAIN's statement said. "The countless reports of disrupted, delayed and denied care streaming in from the original five counties are still very fresh in the minds of all stakeholders."