The Florida Influencer Series

Florida Influencers: Medicaid expansion should be top health care priority for Tallahassee

The emergency room at Miami’s Jackson Memorial hospital is a busy place. The Florida Legislature decided to keep its current Medicaid funding formula on Wednesday, and that was worth $58 million to Jackson.
The emergency room at Miami’s Jackson Memorial hospital is a busy place. The Florida Legislature decided to keep its current Medicaid funding formula on Wednesday, and that was worth $58 million to Jackson. Miami Herald file photo

More from the series

The Florida Influencers Series

This election year, the Miami Herald, the Bradenton Herald and El Nuevo Herald are driving a conversation on the important issues facing our state. We’ve assembled a panel of 50 influential Floridians to offer their views.

In 2015, Florida lawmakers rejected a plan to expand Medicaid under the Affordable Care Act. Ahead of the 2018 elections, a panel of the state’s leading voices is urging the next governor and legislature to revisit that politically charged battle, calling it the most pressing health care matter facing the state.

In the latest survey of the Florida Influencers, respondents were asked to rank six proposals to address health care concerns in the state by order of importance. A clear majority -- 69 percent -- said Medicaid expansion should be at the top of the list.

“The top priority should be the expansion of Medicaid to assist those who do not have the access to medical assistance throughout our state,” Rhea Law, the chair of the Florida offices of the law firm Buchanan Ingersoll & Rooney. “The expansion would also help insure that hospitals in the rural areas will remain viable and open to serve their communities.’’

Three years ago, state lawmakers considered several proposals to expand Medicaid that failed to advance due to opposition from the Republican-led House and Gov. Rick Scott, who is running for U.S. Senate this year.

Florida is one of 17 states that has not expanded Medicaid, which provides health coverage for low-income Americans, since 2014. According to the most recent data from the U.S. Census Bureau, 12.5 percent of Floridians lack health insurance, the third-highest rate in the nation.

“Because a person’s health affects all aspects of their life, we urge the Florida Legislature and our next governor to prioritize this issue on their agenda and expand access to quality healthcare for all working families in Florida,” said Maria Alonso, the president and CEO of United Way Miami-Dade.

But some Influencers warned about the costs associated with expanding Medicaid. Al Cardenas, a senior partner at Squire Patton Boggs who previously chaired the American Conservative Union and the Florida Republican Party, said new health care legislation should be the responsibility of the federal government.

“Health care is already 40 percent of our state budget. We can’t spend much more or other important services, like education, will suffer,” Cardenas said. “We should consider expanding Medicaid coverage without increasing eligibility opportunities.”

In the lead-up to the November midterms, the Influencers, a group of 50 prominent figures from a variety of backgrounds across the state, will weigh in with their ideas on how to address the most pressing policy problems facing Florida. Readers of the Miami Herald, Bradenton Herald and el Nuevo Herald identified health care as one of the five issues most important to them this election year.

Aside from Medicaid expansion, 16 percent of the Florida Influencers said creating a national “Medicare for All” system should be the top health care priority. Another 16 percent went in the other direction, saying repealing the ACA completely is the most important health care issue facing the state and the country.

Proposals to restore Obamacare to its original form and strengthen anti-abortion laws in the event of the Supreme Court overturning Roe v. Wade were the top concerns for even fewer Influencers. However, 58 percent of those surveyed ranked restoring the ACA as the second-most important proposal. And only one Influencer said doing little, because current health care programs are sufficient, was the best approach.

The Influencers also offered up some additional ideas to address Florida’s health care problems. Steve Zack, a partner at Boies Schiller Flexner and former president of the American Bar Association, encouraged lawmakers to direct more funding to programs that focus on early childhood care. Jaret Davis, a co-managing shareholder at Greenberg Traurig’s Miami office, advocated for telemedicine programs.

And Wellcare Health Plans CEO Ken Burdick said “social determinants of health,” such as access to food, education or housing, needed greater attention.

“It’s difficult to prioritize your health when you don’t have access to healthy food or lack reliable transportation to and from your doctor’s office,” Burdick said. “Addressing social determinants requires broad support from our political leaders, community-based organizations and social services, and the entire medical community to find innovative ways to better integrate social services into the delivery of care.”

Readers who participated in this week’s conversation using the “Your Voice” online tool wanted to know whether the state could provide universal health care coverage for Florida residents in a financially responsible way.

Few Influencers saw that as a realistic outcome in the short term. Those who supported universal health care argued lawmakers would need to tackle other measures first.

“Providing universal health care in Florida is possible but not probable,” said Victoria Kasdan, the executive Director of We Care Manatee. “Expansion of Medicaid based solely on income would be the first step in looking at this option and doing more studies and test runs particularly in the areas of highest need in each county.”

Brian Keeley, the president and CEO of Baptist Health South Florida, identified a different starting point: restoring the individual mandate, a pillar of the ACA that the GOP-controlled Congress repealed last year.

“Like car insurance, to have a viable and stable market for health insurance everyone must be in same risk pool,” Keeley said.

Some Influences did not see government-funded universal health care as an option. David Mica, the executive director of the Florida Petroleum Council, contended that the issue should be in the hands of the private sector.

“Doing so will be no easy task, as there are many lives at stake, especially the poor and special needs citizenry,” Mica acknowledged.

With Florida’s primary elections set to take place Tuesday, the Influencers were again asked how well they think candidates running for office are focusing on policy solutions. Here’s how they responded:

  • Very well: 0 percent

  • Fairly well: 11 percent

  • Somewhat well: 52 percent

  • Slightly well: 22 percent

  • Not all well: 11 percent

  • Too early to say: 3 percent

This is the sixth of a series of surveys the Miami Herald and the Bradenton Herald will conduct with 50 Influencers through the November elections to help focus media and candidate discussion around the policy issues of most importance to Floridians. Look for the next report on Sept.10 when Influencers will talk about Florida’s efforts to help the large number of Puerto Rican residents who have moved to the state after last year’s devastating hurricane on the island. Share your thoughts and questions about the state’s important policy challenges and solutions here.

For more reaction from our Influencers on health care issues, look for their quotes on Tuesday’s Opinion page.

George Haj contributed reporting.

Adam Wollner, 202-383-6020, @AdamWollner