Last week, the Florida House rejected the Senate’s FHIX Medicaid expansion bill. It changed tremendously over the past two months. As it evolved, the state cost increased, the coverage dropped and there was still no chance that the federal government would have approved the plan as written.
Yet, every iteration was Medicaid expansion: an entitlement program to primarily serve able-bodied adults with no children.
We should be proud that Florida provides a strong safety net for people who cannot provide for themselves. We invest billions of dollars to make healthcare affordable for children, the elderly and the disabled. Today, Medicaid covers 60 percent of all births in Florida and nearly four in 10 Florida children.
Florida also has a program called “Medically Needy” which pays unaffordable medical bills for poor and middle-class Floridians — a program the Senate plan would have eliminated. Also, working Floridians who make as little as $11,770 can buy private insurance with a federal subsidy. It’s a non-entitlement program that serves 1.6 million people.
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Since the federal government created Medicaid in 1965, Florida has never provided coverage for able-bodied adults with no children. Over the past 50 years, before Obamacare, Democratic and Republican administrations supported this decision. It makes sense. If we provide an entitlement to people who are able to help themselves, we unnecessarily take away from our safety net, education system, environment, public safety and roads.
So why is Florida being asked to reverse our long-held policy and expand entitlements to people who can provide for themselves? Aside from the proponents’ political goals, there are three driving factors.
▪ First, the U.S. Supreme Court struck down the Obamacare Medicaid expansion mandate. Now, the federal government is trying to get Florida to expand “voluntarily” by threatening to take away other money: Florida’s Low Income Pool (LIP) that helps pay for hospital care for uninsured people. According to an independent analysis, even if we expand Medicaid, we’ll still need a LIP program. Tying the two programs together is illegal, and we strongly support Gov. Rick Scott and other states that are suing over this coercion.
▪ Second, under federal law, hospitals must provide care to uninsured people. Florida hospitals think putting more people on Medicaid will fill the holes in their budgets. But hospitals in expansion states found that treating more people with lower Medicaid reimbursements did not improve hospital margins. Medicaid expansion makes hospitals’ financial problems worse, not better.
▪ Third, businesses face federal fines and taxes under Obamacare. It’s why traditionally conservative business organizations urged us to expand Medicaid. If Florida businesses don’t comply with the employer mandate, they get penalized. We do not support these penalties, but we also don’t believe the answer to this flaw is to shift those costs to all Florida taxpayers.
The real problem in healthcare is out of control and unsubstantiated cost. High costs reduce access to medical services and coverage — for everyone. Expanding broken entitlement programs does nothing to provide better and more affordable healthcare. A long-term solution is to attack cost drivers while maintaining a strong safety net for those truly in need.
We need price transparency, so people know what a service will cost and can make informed choices about providers — competition will drive down cost. We need telemedicine without restriction, so Floridians have access to care regardless of where they or their providers are. We need more innovations like direct primary care, which cuts costs by eliminating the administrative hassles of the third-party payer system and restores the patient-physician relationship.
We need to eliminate unnecessary regulations, like the certificate-of-need market-entry barrier; arbitrary restrictions on ambulatory surgical centers; and practitioner restrictions that are based on anti-competitive protectionism, not quality of care. And we need serious medical malpractice reform. We have advanced many of these issues in the current Special Session and we hope our partners in the Senate will give these ideas a fair hearing.
We remain committed to finding ways to increase access, reduce costs, improve quality and help people get coverage. We are not enticed by the promise of “free money” from Washington that will ultimately disappear, leaving Florida on the hook for billions of dollars in new entitlements.
Maintaining a strong safety net and reducing the cost of health care for all is a real solution for Florida.
Rep. Steve Crisafulli, R-Merritt Island, is speaker of the Florida House of Representatives.