Critics pounced after the Senate released its long-awaited bill to dismantle President Barack Obama's health care law on Thursday, saying its proposed cuts to Medicaid could be disastrous for the roughly 3.6 million Florida residents who rely on the program.
Beginning in 2020, it would limit the federal funds Florida and other states get for Medicaid, a program whose expansion was a key part of the Affordable Care Act. Medicaid currently provides all the money needed to cover eligible recipients and procedures for millions of newly insured people.
The Senate bill would lock in Florida's already low Medicaid funding for the next decade or more, making it difficult to keep covering eligible Floridians and leaving little money for public health threats such as Zika, warns Joan Alker, executive director of the Center for Children and Families at Georgetown University.
"The state will have very bad choices: They will either have to raise taxes, reduce benefits or enrollment in Medicaid or cut other areas of the state's budget like education," she said.
While other states broadly expanded Medicaid under the Affordable Care Act, Florida kept one of the nation's stingiest Medicaid programs, offering relatively low reimbursements to providers and limiting eligibility based on income to poorer children and their parents, pregnant women, people with disabilities and seniors in nursing homes.
Despite this, half of Florida's children and three in five nursing home residents depend on Medicaid and its Children's Health Insurance Program, according to a June 2017 report by the Kaiser Family Foundation.
"It cuts health and medical care for our neighbors who need it the most to provide tax cuts to the rich. It does the most damage through a radical restricting of Medicaid ... that will cause families to lose care," U.S. Rep. Kathy Castor, a Democrat representing the Tampa area, said during a Thursday telephone press conference.
Despite opposition to Medicaid expansion by Gov. Rick Scott and Florida's Republican-led legislature, the Sunshine State has led the country in enrollment on the Affordable Care Act exchange, with nearly 1.7 million consumers. More than 1.2 million of them receive subsidies to help pay their premiums.
Trump has threatened to discontinue these subsidies, and some insurance companies say they are abandoning some markets and boosting premiums in part because of uncertainty over the future of the cost-sharing payments.
But there's no death spiral in Florida, judging from preliminary numbers released by the state on Thursday that show six insurers plan to sell coverage in the state through the federal marketplace in the coming year.
These insurers, together with three companies that don't sell premiums on the marketplace, have requested an average rate increase of nearly 18 percent, the state said. But the approved increases will likely be lower, and individual health premium increases tend to vary widely. Last year, some insurers even requested to lower their rates.
Florida Blue, the state's largest insurer on the Affordable Care Act marketplace, says it will keep covering people in all 67 counties, but warns that without the cost-sharing targeted by Trump, its rates would increase by another 20 percent on average.
The Senate bill would effectively remove the Obama administration's incentives and disincentives that have encouraged individuals and companies to invest in broader health coverage. Consumers purchasing coverage through the Affordable Care Act marketplace would get less-generous tax credits, tax penalties would no longer apply when people don't buy insurance and larger companies don't offer it to their employees.
Instead, the Senate proposal aims to shore up insurance markets around the country by creating a pool of $50 billion that states and insurers could tap into to lower out-of-pocket costs for millions of lower-income people.
The measure immediately encountered enough opposition from GOP senators to block passage. Democrats are uniformly against it, saying its true purpose is cutting nearly $1 trillion in taxes over the next decade, mostly for corporations and the richest families in America.
Sen. Marco Rubio said he's invited Scott and state House and Senate leaders to send staff to Washington next week to craft propsed changes.
Scott discussed the bill on Fox News on Thursday, saying people with pre-existing conditions should be protected and the federal government should let states decide how to spend tax dollars on health care.
"Whatever they do, they've got to treat states fairly. Right now in our basic Medicaid plan we get $14 billion from the fed government. We're bigger than New York with more people on Medicaid and they get $23 billion from the fed government," said Scott, a former health care executive. "Tell me how that's fair."