Can the deep-red Florida statehouse follow Virginia and expand Medicaid?
Highly unlikely anytime soon, many state political analysts say.
It’s been three years since the Florida Legislature last debated — and overwhelmingly rejected — Medicaid expansion under the Affordable Care Act.
Republicans — who have controlled the governor’s office and both legislative chambers for nearly all of the past two decades — have shown no interest since then in pursuing the policy that would make about 660,000 uninsured adults eligible for the government insurance program for the poor.
While Democrats are expected to gain statehouse seats in the midterm elections, it’s unlikely they can capture enough to make a difference. That’s especially true in the House where the GOP holds a 76-41 majority, with three seats vacant. Six GOP House members don’t even face an opponent.
“I don’t see Medicaid expansion having much of a chance,” said Carol Weissert, Florida State University’s chair of civic education and political science. “It’s a combination of the political reality on the ground, and I don’t see a huge push for it around the state.”
While healthcare is typically a big issue in retiree-heavy Florida, gun laws and education are likely to play heavy on voters’ minds this fall after the Feb. 14 massacre at Marjory Stoneman Douglas High School in Parkland, where 17 people were killed.
Susan MacManus, a political science professor emeritus at the University of South Florida in Tampa, said one “long shot” for the Democrats’ fall election prospects is a growing percentage of younger voters. They tend to be more supportive of expanding Medicaid, she said.
Although it’s still four months until Election Day, expansion proponents are unlikely to pull off a repeat of what happened in the Virginia House of Delegates election last November, Weissert said. Democrats there captured 15 GOP seats and came within one vote of controlling the assembly.
That shock helped persuade a few GOP lawmakers to join Democrats to push Medicaid expansion through a legislature that had staunchly rebuffed it for four years. Many freshman Virginia Democratic lawmakers campaigned on this issue and other measures that would make healthcare more accessible.
About 400,000 people in Virginia are expected to gain coverage from expansion.
Florida is one of 17 states that have not expanded Medicaid since 2014, and only Texas has more residents who could benefit. An expansion would drop Florida’s uninsured rate from 15.7 percent to nearly 11 percent, according to the nonpartisan Urban Institute.
Republican leaders in Florida have cited various reasons for opposing this step. They say the state can’t afford it. They assert that Florida can’t trust the federal government to pay for at least 90 percent of costs for the newly eligible. They also argue that Medicaid coverage should not go to non-disabled adults because the state is straining to cover children, pregnant women and people with disabilities.
“Medicaid expansion would do nothing to increase competition, reduce cost and therefore create more access,” said Jose Oliva, the incoming speaker of the Florida House, which is all-but-guaranteed to remain in Republican control following the mid-term elections. “The only thing expanding Medicaid would do is create further pressure on a system created as a safety net to help low-income people and to subsidize some elderly care. It wasn’t designed to do what people are trying to get it to do.”
Oliva, R-Miami Lakes, said healthcare remains his top priority. But he says he’s focused on cutting the cost of healthcare by targeting the prices charged by hospitals, noting that roughly 40 percent in the state’s $89 billion budget is already dedicated to healthcare-related expenses.
In the top-down order of the Florida House, that makes the chances of a Medicaid expansion unlikely. But in looking at the issue in the gubernatorial races, the good news for expansion proponents is that Gov. Rick Scott, a Republican who opposed the health law and briefly supported Medicaid expansion then opposed it, is leaving office.
Scott is running for the U.S. Senate against incumbent Democrat Bill Nelson.
While the leading Democratic candidates for governor back expansion, the top Republican candidates, including state agriculture Commissioner Adam Putnam and U.S. Rep. Ron DeSantis, are firmly against it. The state’s primary election is Aug. 28.
But if a Democrat could gain the governorship, it would at least give Medicaid advocates some negotiating leverage, said MacManus.
“A Democratic governor could have some influence on the Legislature down the road,” she said.
Gregory Koger, professor of political science at the University of Miami, said the party not controlling the White House usually does well in mid-term elections and expects Florida Democrats to benefit. President Donald Trump’s low approval ratings, he added, should also help them.
Although the odds are long, he said, the GOP’s failure to repeal the health law last year in Congress might sway some Republicans in the Florida Legislature to vote for expansion, particularly if the plan included a work requirement for those gaining coverage.
“That could give Republicans political cover,” Koger said.
Florida voters seeking expansion will not be able to follow Maine’s lead on a voter referendum on Medicaid until at least 2020.
Maine’s successful 2017 voter referendum ignited interest in other states, including Utah, Nebraska and Idaho, where voters are expected to address the measure in the fall.
Jonathan Schleifer, executive director of the Fairness Project, which is directing the ballot initiatives, said there wasn’t enough time this year to launch an effort in Florida.
“It was premature to do in Florida because we needed a larger runway for the work,” he said. “It would have been impossible to put together that many signatures.”
Schleifer said he sees strong public support for expanding Medicaid and hopes that after more states approve the ballot referendum, it will make it easier to accomplish in the Sunshine State.