The Florida Senate capped one of the most politically divisive debates in decades Wednesday and gave bi-partisan approval to a plan that draws federal Medicaid money into a privately run program to provide subsidized health insurance to low-income, working Floridians.
The measure, named the Florida Health Insurance Affordability Exchange, or FHIX, program, passed by a 33-3 vote on the third day of a three-week special session. It will be voted on Friday in the House, where early counts show the measure might be 11 votes short of passage in the 120-member chamber.
The Senate adopted a series of last-minute changes aimed at quieting concerns from House Republicans and Gov. Rick Scott. But, despite the revisions and an appeal by Senate leaders to show this was a “Florida plan” and not traditional Medicaid expansion, Scott did not budge.
“He has not revised” his opposition, said Scott spokesman Jackie Schutz after the Senate vote.
Senate President Andy Gardiner predicted that if the House rejects the plan, the issue will not go away.
“I may not be the presiding officer when this proposal finally makes it but this is the future. It just is,” he said as the Senate ended the four-hour debate.
He noted that the state budget must devote millions this year to offset the loss of federal dollars intended to reimburse hospitals that serve the uninsured, and that problem will continue to vex Florida until the state comes up with a plan. “It’s in the House’s hands now,” he said.
The governor’s rigid opposition is a reflection of the tense ideological debate that has deeply divided Republicans since the Senate realized the state was set to lose federal Low Income Pool funds to reimburse hospitals that serve the uninsured.
The governor has sided with House Republicans in opposing using funding from the Affordable Care Act, known as Obamacare, while the Senate wants to use the Medicaid funds to create a state-run alternative that could help up to 650,000 uninsured buy low-cost coverage and offset the lost federal dollars.
Under the plan, not every uninsured person would qualify. Participants must be able to prove that they are working, actively seeking work, in school, disabled or caring for a disabled relative to receive support through the program.
The plan, SB 2-A, had been amended twice this week, before being approved in unanimous committee votes. The debate began Wednesday with another round of amendments, this time aimed at addressing the concerns of the state’s top Medicaid chief, Justin Senior, who said the original bill would reduce the number of insured.
Agency for Health Care Administration Secretary Liz Dudek said those changes alleviate some of the the administration’s concerns but agency officials still believe that other elements “make it uncertain whether the FHIX plan will be able to provide more Floridians with health coverage.’’
Lawmakers convened the session after an impasse over health insurance stalled progress on the state budget. Senate leaders, however, used the budget to make their argument the plan was needed now.
Since the Senate first proposed drawing down federal Medicaid funds to help the more than 800,000 uninsured in the state, the federal government confirmed that it is cutting payments for the LIP funds by $1.2 billion. By reducing the number of uninsured and drawing down billions in federal Medicaid money, the state’s top economist testified Florida could save $1 billion over the next 10 years.
“If you want more money for education, and we all do, then we need to pass a plan that draws down federal money … rather than shelling out state money for health care,” said Sen. Aaron Bean, R-Fernandina Beach, sponsor of the latest version of the FHIX plan.
Several senators pointed out that Scott and the House aren’t opposed to accepting federal funds, since the governor is suing the federal government for threatening to renege on LIP funds. They’re just opposed to using the Medicaid funds.
Sen. Don Gaetz, R-Niceville, said that while the House opposes taking Obamacare funds, it built its budget using $24 billion in federal funds so it has “lost its virginity on that issue.”
Bean and other conservatives argued that by investing $1.8 billion, the state would return another $18 billion to pump into federal subsidies that Florida, not the federal government, could control.
“Medicaid is growing $1 billion a year whether we like it not,” said Sen. Wilton Simpson, R-Trilby. “I believe this is our opportunity to cut billions of dollars out of the Medicaid issue because we have private solutions.”
He said the bill not only will protect the state budget and its credit rating by containing the growth of Medicaid, it will help employers and the public.
“In Trilby, where I live, there are a lot of poor folks and they will be greatly benefited by this bill,” he said.
Senators used the four-hour debate to win votes in the House.
Senate Majority Leader Bill Galvano, R-Bradenton, noted that his amendment requires the Senate plan to expire on July 1, 2018, unless it gets renewed by the Legislature and includes a commission that will oversee its implementation.
Bean, a former auctioneer with the cadence of a pitchman, called it a “three-year test drive” that in the event it doesn’t work out “we get to return it, no questions asked.”
Sen. Garrett Richter, R-Naples, said he was a skeptic about using federal Medicaid money to develop a Florida plan before this year but, after studying the issue, he concluded “it would be irresponsible” to walk away from the federal funds and expect Florida taxpayers to fill the budget hole that will only expand as Medicaid grows.
“We can’t close our eyes and cross our fingers and hope the problem will go away,” he said. “Floridians deserve a return on their taxes.”
Gaetz, a former senate president, urged the House to accept the Senate changes and send the bill back with improvements of their own.
“You who are so strident in your opposition to the federal government, don’t be the first to raise the white flag – join us,” he said.
Three conservative Republicans, Sen. Jeff Brandes of Tampa, Alan Hays of Umatilla and Travis Hutson of Jacksonville, opposed the bill but remained silent during the four-hour debate.
After the vote, Brandes said he objected because he does not believe in expanding the federal debt to help Floridians get insurance.
“We’re borrowing all that money from future generations,” said Brandes after the vote. “This plan is built on hopes and dreams and not reality.”
Staff writer Michael Auslen contributed to this report.
Mary Ellen Klas can be reached at meklas@MiamiHerald.com and on Twitter @MaryEllenKlas