The Florida case for Medicaid expansion

The United States is the only advanced country in the world without some form of universal healthcare to cover all its citizens. This is about to change with implementation of the Affordable Care Act (ACA) passed by Congress in 2010.

Some 30 million more Americans are scheduled to obtain health insurance through private health insurance exchanges or expansion of the state Medicaid programs. This is a welcome development, not only for the currently uninsured, but for the rest of society that currently subsidizes uninsured patients’ medical bills through their own insurance premiums.

In Florida, our lawmakers decided not to establish a state exchange for access to private health insurance plans, so a federal insurance exchange will take its place. Our lawmakers also decided not to participate in the Medicaid expansion program, even though the federal government agreed to pay 100 percent of the cost the first three years and most of the cost thereafter.

The decision to decline an estimated $51 billion in federal Medicaid subsidies to expand the Florida Medicaid program under the ACA will hurt everyone in Florida, starting with the 1 million poor and low-income Floridians who will not gain access to the state Medicaid program. It will hurt healthcare providers, like hospitals and physicians, who agreed to lower levels of federal reimbursement in return for the reduction in the number of uninsured that would result from implementing the Affordable Care Act.

The refusal to expand Medicaid will also negatively impact the large majority of Florida employers who provide commercial insurance to their employees — and the workers who purchase their own private commercial insurance.

This happens through another “hidden tax” that Americans have been paying for years through an existing unfunded government mandate: The Emergency Medical Treatment and Labor Act (EMTALA). This law requires all hospital emergency departments and emergency department physicians to screen — and treat as appropriate — all those who seek care coming through their doors, whether they can pay or not.

People who don’t have health insurance and access to private doctors and primary care centers end up in the emergency room when they get sick, tapping the most expensive way to treat what otherwise might be minor ailments. Many are admitted to the hospital. Since these patients cannot pay their bills, their cost is passed on to those who can — private patients with commercial insurance.

This decades-old “cost shift” is another compelling argument for expanding insurance coverage under the Affordable Care Act.

I urge Gov. Rick Scott to call a special session of the Florida Legislature and strongly encourage our lawmakers to make the best decision for the people of Florida: Expand Medicaid and share in the $1 billion available this year.

If the Legislature doesn’t act, we will all pay a price — and that doesn’t make sense under any scenario.

Brian E. Keeley is president & CEO of Baptist Health Florida

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