Gov. Rick Scott has said what he would do. So have the other three members of the Florida Cabinet.
But it is the Legislature that will ultimately decide whether the state will expand Medicaid under the Affordable Care Act. House and Senate committees studying the health care law could make their recommendations Monday.
Rep. Richard Corcoran, the Land O’Lakes Republican who is chairing the House committee, said earlier this week he remains "skeptical" about adding roughly 1 million Floridians to Medicaid. "There’s clearly cost issues, you’ve seen that through the testimony," he said.
If the Democratic caucus holds strong in the House, they would still need 17 Republicans to support Medicaid expansion to get a bill passed. So far only one, Rep. Mike Fasano of New Port Richey, has pledged to cross party lines.
The House and Senate committees are meeting jointly Monday to hear from Amy Baker, the state’s chief economist, and a representative from the National Center for Policy Analysis, a "free-market" think-tank that has been critical of Medicaid expansion.
Then, each panel will meet separately to discuss options and try to reach, if not a consensus, at least a conclusion that the majority supports. Indications are the Senate committee is leaning toward embracing Medicaid expansion in some fashion while the House committee appears opposed.
Senate President Don Gaetz, R-Niceville, said that if the House opposes an expansion, senators would insist on an alternative that expanded access to health insurance.
"I think the Legislature can’t say, ‘No, no, hell no,’ ’’ he told the Miami Herald’s editorial board last week. "If the answer of either the House or the Senate is not Medicaid expansion, then there has to be some policy alternative. Otherwise we’re being naive."
Sen. Joe Negron, the Stuart Republican who chairs the Senate special committee, said lawmakers have asked to discuss how hospitals would be affected if the state decides to pass up the federal dollars to expand Medicaid — since other cuts coming down the pipeline will decrease hospital revenues.
The Legislature also might want to dig into how other states are tackling the issue. Lawmakers in Arkansas, for example, received federal approval to use their Medicaid expansion dollars to send people to health exchanges to shop for private insurance. In Indiana, the governor has asked the federal government to use the state’s health plan for low-income residents instead of traditional Medicaid.
Scott said he would support a three-year trial run for Medicaid expansion that would end unless the Legislature votes to keep it going. If the federal government breaks its promise to pay 100 percent of the expansion costs during that time, the state would also opt out.
Agriculture Commissioner Adam Putnam and Attorney General Pam Bondi criticized Scott’s proposal almost immediately, citing the long-term costs of Medicaid expansion.
Chief Financial Officer Jeff Atwater remained silent on the issue until he was asked to respond Friday during a meeting with the Times’ editorial board.
Atwater said he was on the same page as Bondi and Putnam.
"This is going to obligate us to either in future years to a Legislature that will significantly change the tax code, or this takes [away from] education dollars, transportation dollars and everything else," Atwater said. "I look at the general revenue stream. It will not carry this. It’s just that simple."
Herald/Times staff writers Mary Ellen Klas and Adam Smith contributed to this report.