Florida’s uninsured working adults should thank Sen. Rene Garcia of Miami-Dade County for keeping alive the debate over healthcare coverage.
As a poverty health lawyer, I’ve worked on healthcare-access issues for 30 years. In all those years, there has never been a more important debate than whether to accept federal funding under the Affordable Care Act (ACA) for coverage of low-income Floridians.
Unfortunately, Florida’s 2013 House of Representatives defeated a bill that would provide coverage for these individuals, most of whom work for small employers who are not required to provide insurance. Until Sen. Garcia introduced his bill, the common wisdom was that the 2014 Legislature would not even consider options for such coverage.
Under the ACA, states were required to expand Medicaid to cover most low-income adults, and virtually all of the cost would be covered by the federal government. However, the Supreme Court, while upholding the individual mandate as constitutional, also held that the Medicaid expansion requirement was a state option.
Much has been written about the obvious economic boon to the states that choose to accept the federal funding. It is well documented, for example, that Florida would receive more than $50 billion in new federal funding over the next 10 years, and more than 100,0000 new jobs would be created if the state exercised this option.
Less well known is the fact that states like Florida, which rejected the federal funding, have, tragically, created a new “coverage gap.” The ACA was designed to reduce the number of uninsured Americans by extending Medicaid to those below 138 percent of the federal poverty level and providing assistance in paying for private plans in the ACA marketplace for those between 100 percent and 400 percent of poverty .
However, over 750,000 Floridians, including over 250,000 people in Miami-Dade County, make too little money to get help with buying insurance and do not qualify for Florida’s extremely limited Medicaid program. Florida’s Medicaid program mostly covers children; the only adults currently eligible are extremely poor people with severe disabilities and parents of minor children. For example, a single parent with one child can only earn up to $5,400 a year (about 30 percent of the federal poverty level) in order to be eligible.
So, while people whose income is at or above the poverty level ($11,490 to $46,960 a year for a single person) can get generous help to cover the cost of insurance in the marketplace, those who make less than the poverty level remain uninsured. If Florida exercises its option for federal funding, as provided in Sen. Garcia’s proposal, the same single parent could earn up to $21,400 a year and get federally funded health insurance.
Significantly, while Medicaid costs have traditionally been shared equally by the state and federal governments, the federal government will pay for 100 percent of the costs of the newly covered population for the first three years, tapering to no less than 90 percent. In other words, when a person on Florida’s current Medicaid program is enrolled in an HMO, the state and federal governments split the cost. But if Florida expands coverage as envisioned under the ACA, the cost of HMO enrollment for newly eligible adults would be paid almost entirely by the federal government.
Most states have already taken federal dollars either to expand their current Medicaid programs or to create new programs that similarly draw down federal funds for covering uninsured adults. This means that Floridians are spending their federal tax dollars to pay for health insurance for low-income workers in other states and for communities in other states to reap the economic benefits of this unprecedented influx of federal funding, while our citizens and communities go without.
This is wrong. We all need to rally around Sen. Garcia, and make sure that his bill is not only debated, but passed.
Miriam Harmatz is senior health-law attorney with Florida Legal Services Inc. in Miami.