With rising cases of HIV/AIDS, more deaths from heart disease and diabetes than Florida averages, and the greatest number of uninsured working-age adults in the state, Miami-Dade County faces a growing public health crisis that threatens to overwhelm hospitals and raise costs for all residents, according to a report issued Wednesday by a healthcare advocacy group.
The report from Florida Community Health Action Information Network (CHAIN) advocates strongly for state legislators to expand eligibility for Medicaid to nearly all low-income adults, as envisioned in the Affordable Care Act, as the solution to Miami-Dade’s looming emergency.
“It’s the answer that will solve most of the problems,” said Laura Brennaman, author of the report and Florida CHAIN’s policy and research director.
Florida’s Legislature, however, has refused to expand coverage, a decision that leaves an estimated 567,000 residents statewide uninsured.
Last year’s debate over a proposal for Medicaid expansion, which the Senate supported but the House and Gov. Rick Scott opposed, created a deadlock that led the Legislature to end abruptly and forced lawmakers to reconvene months later to adopt a state budget.
This year, legislators again declined to expand coverage under Medicaid. But they were forced to accept a drastic reduction in federal funding that pays hospitals for treating the uninsured, and to change the way Florida distributes those diminished dollars to hospitals with the greatest need.
One of the chief arguments that Republican leaders of the Florida House have made against expansion is that they do not want to create more taxpayer-funded entitlements that would be hard to repeal. They also have expressed concerns about the costs.
But Brennaman’s report drew from state and federal hospital reports to show that Florida’s refusal to expand Medicaid will be more costly, particularly for Miami-Dade hospitals, which will lose more than $241 million this year due to a severe reduction in federal funding for uninsured patients.
She also noted that Florida spends about $1.6 million a year to provide antiretroviral drugs to 4,500 uninsured HIV-positive people in Miami-Dade — a cost that would be absorbed by the private insurers managing the state’s Medicaid program if legislators were to expand coverage.
Martha Baker, a trauma nurse and president of SEIU 1991, the labor union for doctors and nurses at Miami-Dade’s public hospital network, Jackson Health System, joined Brennaman at a press conference to release the report on Wednesday.
An advocate of Medicaid expansion, Baker said increased coverage would help deliver more efficient care for uninsured Miami-Dade residents by emphasizing preventive medicine.
She said Jackson Health spends a lot on “sick care,” and used the example of Miami-Dade residents with uncontrolled chronic diseases, such as diabetes, who show up in the emergency room in a crisis and have a limb amputated.
“It’s sad,” she said. “We can’t pay to take care of patients who need healthcare except in the most expensive way.”
But Florida is not likely to expand eligibility for Medicaid for at least another two years, said Mark Pafford, president of Florida CHAIN and a past Democratic leader in the Florida House.
“It’s not politics,” he said, noting that members of the Florida Senate who strongly advocated for and approved a Medicaid expansion plan have not been voted out of office or faced other political consequences.
“It’s something more insidious,” Pafford said.