Marc Caputo: House GOP’s balking at Medicaid cash could hurt party

04/14/2013 4:41 PM

04/15/2013 3:22 AM

"Republicans don’t care.”

Lenny Curry, the Republican Party of Florida chairman, reluctantly acknowledged the criticism in an email. And he proposed an antidote.

“It’s not enough to say that we care about people,” Curry wrote, citing a conservative columnist. “You have to show up.”

The following day, Thursday, Florida House leaders showed up in the state Capitol, pitched a conservative health plan and played right into the don’t-care criticism.

They said they didn’t care to take nearly $9.8 billion from the federal government over three years to help provide coverage to as many as 816,000 low-income Floridians. Their plan covers fewer people and costs the state treasury more money than proposals by Republican Gov. Rick Scott or the GOP-led Senate, who want to take the federal money for at least three years by expanding the Medicaid program.

$55 billion at stake

The federal money, as much as $55 billion over a decade, would go a long way in a state where about one in four non-elderly residents is uninsured — the third-highest rate in the nation.

The House’s intransigence over expanding Medicaid doesn’t mean Republicans don’t care.

They care.

About GOP primary elections.

Taking the money risks exposure to potential opponents who will tar them for taking Medicaid money under Obamacare. It gives President Barack Obama a win.

But if Republicans care about general elections, too, they might want to take a look at the fastest-growing and most-sought-after segment of the electorate: Hispanics.

Hispanics account for about 35 percent of Florida’s Medicaid-eligible population.

The Hispanic factor

And Hispanics favor Medicaid expansion in Florida, with 60 percent in favor and 28 percent opposed, according to a poll taken in early March by the Associated Industries of Florida, a conservative business lobby. Overall, Florida voters favored it 54-31 percent.

In a Pew Research survey before the 2012 election, Hispanics ranked healthcare as the third-most important issue behind education (1) and jobs (2). It was ahead of immigration (4). The results were similar to a 2011 Pew poll and other surveys.

So while Republicans nationally are talking about the need for immigration reform to get right with Hispanics, the data show Hispanics consistently care more about healthcare.

There’s a reason Obama’s campaign touted Obamacare during the election. In addition to his hard line on immigration, Mitt Romney’s opposition to Obamacare helped drive Hispanics to Obama’s fold.

“Healthcare was one of our top persuasion messages in the Hispanic community,” said Ashley Walker, Obama’s Florida campaign manager.

Obamacare had a downside for some in the healthcare industry: It cut some Medicare reimbursement rates and a type of charity-care money, among other reductions.

Obamacare offset some of those cuts by expanding Medicaid. But when the U.S. Supreme Court upheld Obamacare, it ruled the Medicaid expansion would be voluntary in each state.

So states have a choice: Accept the Medicaid expansion to soften the blow of the cuts. Or bear the full brunt of the cuts and blame Obama.

Moody’s Investor Service reported last week that states that refuse to expand Medicaid could risk the bond ratings, and therefore the financial stability, of some charity-care hospitals (the state’s largest is in Miami: Jackson Memorial).

In elderly-heavy Florida, the Medicare cuts could total about $60 billion over a decade, and the charity-care reductions an additional $2 billion. Another reduction outside of Obamacare, the so-called “sequestration,” could remove $10 billion.

Economic effects

So that’s about $72 billion that could be removed from hospitals and healthcare providers in Florida. In other words, money that could otherwise be injected into the economy.

And that could affect employment in Florida. Tripp Umbach, a consulting company, estimated the sequester cuts could cost Florida 35,827 Medicare-related jobs next year, making Florida the nation’s second-biggest loser behind California.

But taking more Medicaid money under the guise of job-creation directly undercuts an already embattled conservative talking point: Government spending doesn’t create jobs.

It does. It even creates the jobs of politicians and helps fund all the special interests who receive public money and then plow a portion of it back into politicians’ campaign coffers.

And with a budget that could weigh in at $74 billion and could employ almost 115,000 people next year, that’s a lot.

Almost 32 percent of the current state budget is composed of federal money. So it’s not like Florida is going it alone anyway. Still, federal debt is a problem in the long term, and Florida lawmakers are rightly wary of taking “free” federal money.

The last time Republicans made a show of balking at federal money, in 2009, Obama’s stimulus was passed. Then, as now, the Florida House passed a budget that refused the money.

Then-Gov. Charlie Crist and the GOP-led Senate took the cash. The House ultimately buckled, raising taxes by $2.2 billion along the way.

None of the horror stories of how the federal cash would make Florida’s budget or the nation’s economy worse materialized.

But it made Crist’s political fortunes worse. Marco Rubio used Obama’s stimulus to chase the governor out of the GOP; Rubio went on to become a U.S. senator, where he’s working on an issue dear to Hispanics, immigration reform.

Crist’s successor, Scott, railed against the stimulus and Obamacare that year, but then signed a budget stuffed with stimulus money. After spending his personal money and campaign fighting Obamacare, Scott threw in the towel, saying Obamacare’s the law of the land.

Another once-fierce critic of entitlements and government spending, former congressman and past Florida House Speaker Tom Feeney, joined Scott in calling for Medicaid expansion.

Feeney is now the head of AIF, which took the Medicaid poll cited above, and his group estimates that expanding Medicaid would soften the blow or eliminate a maximum $1.3 billion in annual Obamacare business tax penalties for states that don’t insure enough people.

Medicaid growth

But House Speaker Will Weatherford is still saying no. He and House leaders have long been concerned with the growth of Medicaid, which consumes ever-bigger portions of the state budget.

But in his first session as speaker this spring, Weatherford unknowingly praised a Medicaid-related program called “Medically Needy,” which helps catastrophically sick people who can’t pay astronomical medical bills. His parents used Medically Needy money to pay the costs of cancer treatment for his younger brother, who died in 1995.

Last week, the federal government informed the state that it would essentially pick up the state’s entire share of the Medically Needy bill. That would save the state treasury about $436 million next budget year.

The saving is so great (at least $4.5 billion over a decade) that the state could sock away at least $1 billion through 2023 even if it continued with Medicaid expansion after three years, at which point Florida would have to kick in an ever-increasing share of state tax dollars.

If the state opted to stick only with Medicaid expansion for three years, the treasury would save at least $1.3 billion over that time.

That’s money that could be used to pay for other goodies: tax cuts, hometown spending, education, even healthcare.

So let’s review: Taking the Medicaid money (at least for three years) would help people find insurance, shield hospitals from cuts, help the budget, help the economy, help businesses, help people like Weatherford’s own family and perhaps help the GOP continue to attract Hispanic voters and anyone else who otherwise would think that Republicans don’t care.

But if the House GOP gets its way, the rap on their party could be that Republicans care mostly about hating on Obama.

About Marc Caputo

Marc Caputo

@MarcACaputo

Marc Caputo is the Miami Herald's political writer. Hailing from Key West, he graduated from the University of Miami.

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