State Politics

Florida House leaders threaten budget battle over Medicaid expansion

HALFTIME: It’s the halfway point in the Florida Legislature’s 60-day session, which ends May 1. Legislative committees have discussed a long list of issues including whether to allow guns on college campuses, how to change school tests and whether to allow online voter registration and expand Medicaid. PolitiFact Florida reviews the first half.
HALFTIME: It’s the halfway point in the Florida Legislature’s 60-day session, which ends May 1. Legislative committees have discussed a long list of issues including whether to allow guns on college campuses, how to change school tests and whether to allow online voter registration and expand Medicaid. PolitiFact Florida reviews the first half. Tampa Bay Times

The gloves are off inside the Capitol.

The Florida House overwhelmingly approved a $76.2 billion budget Thursday that was more than $4 billion less than the Florida Senate plan passed a day earlier, a discrepancy largely due to the House’s staunch refusal to expand Medicaid.

House leaders are adamant that they aren’t about to back off, even it means that the two chambers, both controlled by Republicans, won’t come to an agreement by the scheduled end of the legislative session in May.

“They want us to come dance?” said House Appropriations Chair Richard Corcoran, R-Land O’Lakes. “We’re not dancing. We’re not dancing this session; we’re not dancing next session; we’re not dancing next summer. We’re not dancing. And if you want to blow up the process because somehow you think you have that right that doesn’t exist, have at it. We’re going to do what’s right.”

Senate President Andy Gardiner, R-Orlando, responded that he wasn’t going to “rant and rave” about the issue of expanding federal Medicaid assistance to the poor. “This is a serious matter,” he said. “This is a $2.2 billion hole, 800,000 people not covered.”

Gardiner insisted that the Senate “believes it has done everything possible to advance solutions to the healthcare challenges facing Florida,” but he left the door open for negotiations. “In the Senate … we’re prepared to have a discussion.”

The Senate by a 36-0 vote approved an $80.4 billion budget that includes a plan for Medicaid expansion. The House approved its budget without one by an 86-29 margin.

The $4.2 billion discrepancy between the two spending plans represents a proxy war over Obamacare.

During more than three hours of partisan debate, House Republicans defended their refusal of Medicaid expansion as a brave populist stand against federal overreach.

“This budget reflects the values that we hold so dear in that the proper relationship with Washington is for us to say, ‘Get your house in order; balance your budget; don’t spend my grandchildren’s money on these hospitals, these health plans, on Wall Street,’” said Rep. John Wood, R-Winter Haven. “We’re tired of it. The people want stability.”

“This budget is good for our middle-class families. It’s good for the future of this great state,” said Rep. Blaise Ingoglia, R-Spring Hill, and chairman of the Republican Party of Florida. “While the federal government and other states continue to get it wrong, this state will continue to get it right.”

For the past three years, Florida has refused $51 billion in federal money earmarked for expanding subsidized healthcare coverage, making it one of 22 states to do so. The Senate is now advancing a plan to expand coverage through the use of a state-run marketplace for private insurance. But House Republicans, who have a commanding 80-39 edge in the House over Democrats, have refused to consider it.

That refusal, Democratic leaders such as U.S. Sen. Bill Nelson say, is why the federal government won’t extend Florida’s $2.2 billion program for hospitals that treat low-income patients.

Twenty-nine House Democrats joined Gardiner in supporting the Senate plan by voting against the lower chamber’s budget, portraying their Republican colleagues as out-of-touch with the mainstream.

“For the past three years, we have continued to find every excuse in the book to not narrow the healthcare gap in Florida,” said Rep. Amanda Murphy, D-New Port Richey. “Our dereliction in duties has left over 800,000 Floridians without affordable healthcare. The consequences for the lack of our action has now resulted in the loss of federal low income pool funding, potentially leaving another 1.4 million Floridians exposed and without the option of seeking a healthcare provider.”

“(Medicaid expansion) isn’t just what the Senate has sent over,” said Rep. Evan Jenne, D-Fort Lauderdale. “It’s what the business community has asked for. It’s what the working poor of the state has asked for. The governor has even looked into it. Right now this chamber is out on an island all by its lonesome.”

But Republicans, led by Corcoran, appear to be forging their own way.

“Come to war with us,” Corcoran told House members. “Come to war with healthcare on us. And I’ll tell you who the enemy is. It’s the status quo.”

While the main difference between the two budgets is over Medicaid expansion, there are other discrepancies.

The Senate’s budget sets aside $2 million for the Florida Forever program, which was created in 1999 to fund public land acquisition and was initially authorized to spend $300 million a year. The proposed amount represents an 84 percent cut from this year’s budget and $118 million less than what Gov. Rick Scott proposes.

The House says it has set aside $205 million for Florida Forever, but most of that money is actually tied to other projects, such as reservoirs, springs restoration and other programs, leaving only about $10 million for the land acquisition program.

The House is proposing a $21.1 billion education budget. The plan increases spending on K-12 schools by $708 million, or 3.5 percent, and proposes $7,130 be spent on each student.

The Senate’s proposed $21 billion education budget isn’t all that different.

Senators want to give an additional $745 million to K-12 schools. They have suggested increasing per-student spending by $208 to about $7,123. That’s not quite the $7,176 Gov. Rick Scott has proposed, or the figure being considered in the House. But Senate Education Appropriations Subcommittee Chairman Don Gaetz, R-Niceville, has said it is a responsible figure given that enrollment is expected to grow by more than 25,000 students.

Contact Michael Van Sickler at mvansickler@tampabay.com. Follow @mikevansickler. Contact Kathleen McGrory at kmcgrory@miamiherald.com. Follow @kmcgrory.

Bridging the budget gap between the House, Senate

▪ The Florida Senate budget includes $2.8 billion in federal money to expand subsidized healthcare coverage. The Senate does not want to expand Medicaid as envisioned under the Affordable Care Act. Instead, the Senate has proposed the creation of a new, state-run marketplace for private healthcare insurance. Beneficiaries would be required to pay small monthly fees based on their income, and either work or attend school.

▪ The Senate budget also assumes that the federal government will continue a $2.2 billion program that provides funding for safety-net hospitals. Federal health officials have repeatedly said they will not approve the Low Income Pool (LIP) program as it exists today. But the Senate is proposing a new model that would distribute the dollars more broadly than the current model does. The plan would need to win the support of the U.S. Centers for Medicare and Medicaid Services. Negotiations are ongoing.

▪ House Republicans oppose any efforts to expand Medicaid, which they consider to be a broken program.

▪ House Health Appropriations Committee Chairman Matt Hudson, R-Naples, has said he is confident that Florida will receive some amount of federal LIP funding. But he will not include that money in the budget until he knows how much it will be.

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