Fred Grimm

Fred Grimm: Thousands could fall into Florida’s healthcare gap

We now have a numerical benchmark to gauge the legislative malpractice infecting Tallahassee — 850,000 Floridians who’ll be left without healthcare coverage because of mindless political obstinacy.

The Florida House of Representatives, in league with the governor, has refused to extend Medicaid coverage to low-income adults who’ve been left in a kind of healthcare netherworld. Unless the state loosens Medicaid eligibility requirements, some 850,000 Floridians will remain too poor to qualify for subsidized health insurance — aka Obamacare — but not quite poor enough to receive Medicaid coverage.

In Tallahassee, the Medicaid imbroglio has been couched as a budget standoff between the Senate, which wants to accept the federal funds that would flow into Florida with Medicaid expansion, and the House, which will abide nothing associated with Obamacare. The two legislative bodies are left with a $4 billion budget impasse and not much prospect for reconciliation before the session ends next week.

It’s as if those 850,000 Floridians have been relegated to so many digits on a political tally sheet. But as my Miami Herald colleague Daniel Chang reported this week in heart-wrenching detail, the actual human beings caught in that healthcare gap are enduring excruciating struggles.

Dan’s reporting showed that for people getting by on so little, an illness or debilitating accident or chronic health problems can overwhelm their lives. They seek out the limited help offered from the free clinics around or they pay a wildly disproportionate percentage of their income for private health insurance. They scrimp on their prescriptions. Or they try to get by without medicines most of us would consider crucial to good health. They have no hope of undergoing surgical procedures that would allow them to get back into the workforce or alleviate their painful disabilities.

They’re real Floridians, consigned to a kind of misery that has been spared people of the same economic strata in the 28 states (and the District of Columbia), including states run by conservative, Republican governments, that have elected to expand Medicaid.

About 140,000 people in Miami-Dade County have descended into the coverage gap. And another 80,000 in Broward.

It gets worse. After June 30, the federal government has warned that it intends to re-allocate money that has been going into the so-called Low Income Pool to offset costs borne by hospitals that treat large numbers of uninsured patients. Funds to expand Medicaid — and help insure many of those people — are supposed to come into the states via the Affordable Care Act. The upshot: Tallahassee’s intransigence also threatens to rob Florida’s public hospital systems of $1.3 billion a year. Miami-Dade’s Jackson Health System would lose $200 million a year.

Amy Baker, the Legislature’s chief economist, warned lawmakers this week that the loss of the Low Income Pool funding would also have a profound effect on the state economy, including the loss of nearly 20,000 jobs.

We’re left to contemplate the dismal irony of our public hospitals crippled or bankrupted by a political squabble overseen by a governor who once ran the nation’s largest private hospital chain. But here we are.

Gov. Scott said this week that he intends to sue, hoping to force the Obama administration to detach money for the Low Income Pool from compliance with the Affordable Care Act. That hardly sounds like a quick resolution.

All this would go away, of course, if the Republican-run House signed onto the Republican-run Senate’s Medicaid expansion plan, which Hialeah Sen. Rene Garcia noted would provide coverage for “people who are actually working.” The frustrated Garcia, a Republican by the way, with thousands of constituents in his working class district caught in the gap, told the Associated Press, “We are denying access to primary care because of politics, because of political dogma, and that is just wrong.”

The Republican leaders in the House, a famously dogmatic bunch, held a closed door meeting Tuesday to supply their minions with the talking points they’ll sure-as-hell need as their homemade healthcare crisis escalates and the public becomes aware of the needless suffering they’ve caused Florida’s poor.

Reporters and the public were barred from the meeting, flouting the notion of government in the sunshine. That only added to the sense that House leaders were up to something so untoward that they preferred to cower behind closed doors.

Associated Press reporter Gary Fineout, however, was able to listen at the door and hear the House leaders urge Republican house members to resist Medicaid expansion, despite the coming criticism.

What House leaders didn’t seem to discuss were the victims of their political gamesmanship: 850,000 actual people, with real healthcare needs, lost in the gap.