Arkansas' state legislature passed a model plan to expand Medicaid last week, even though its Legislature is dominated by Republicans and the measure had to pass by a three-quarters vote, the Associated Press reports.
The Arkansas plan is the model for Florida state Sen. Joe Negron's plan, which would accept an estimated $51 billion in federal funds over 10 years to expand insurance to about 1 million of the state's low-income uninsured.
According to a recent Florida Medicaid report, the expansion's cost to the state would be offset by savings; several programs the state has been funding for the uninsured would no longer be necessary, the report says. There has not yet been a meeting of the budget estimators to confirm the report.
In Arkansas, as in Florida, the House's conservative Republican Speaker opposed the plan. There, as here, a conservative group financed by the Koch Brothers, Americans for Prosperity, fought it.
But one difference was that Arkansas' governor, Democrat Mike Beebe, fought hard for the plan and went to Washington to negotiate for permission to use it as a substitute for traditional Medicaid. In the end, as AP reported, half of the House Republicans in the state voted for what they called the "private option" plan.
In Tallahassee, Republican Gov. Rick Scott has said he supports the expansion plan, on the grounds that it would be unfair for needy Floridians to go without coverage when those in other states will be covered; also, he said, the state sends tax money to Washington and deserves to get some of it back.
But Scott has said the health-insurance expansion is not a priority for him. Last week, House Speaker Will Weatherford told a reporter in a videotaped impromptu press conference that the governor has not spoken to him about the issue. Weatherford has been the leading opponent of expanding coverage.
Health News Florida asked Scott's spokeswoman Melissa Sellers whether it is true that the governor has not spoken to the House leader about Medicaid expansion.
She responded, "We don't comment on the details of legislative conversations. Governor Scott laid out what he would support from the legislature in February - protecting both the uninsured and taxpayers by providing 1 million Floridians access to care while it is 100 percent federally funded."
The 100-percent funding is for three years. After that it tapers to 90 percent by the year 2020.
As the Washington Post reports, some Republican-dominated states have been swayed by the consequences that would ensue if they don't accept federal funds and expand coverage. The consequences include tax penalties to businesses with more than 50 workers if those workers seek subsidized coverage through the federal exchange.
Associated Industries of Florida has said it supports the expansion. It is not clear how aggressively it is lobbying for the plan.
The Palm Beach Post reported over the weekend that Democrats are frustrated over Scott's failure to push for the plan, and some suggest he paid the expansion plan lip service to soften his image.
Negron's plan emerged after key committees in both the Florida House and Senate voted against Medicaid expansion as it was described in the Affordable Care Act. The ACA wanted states to expand the traditional Medicaid program to cover low-income groups that are now left out, and called for coverage for people with incomes up to 138 percent of the federal poverty level -- about $15, 760 for one person, about $32,500 for a family of four.
But the Supreme Court decided that while the ACA was constitutional, the Medicaid expansion could not be imposed on states; instead it must be offered as an option. Coverage for the expansion population was to be fully federally funded for the first three years, and at least 90 percent federally funded after that.
Instead of expanding traditional Medicaid, the Florida Senate and House came up with alternatives. The Negron plan would accept the federal funds and use them to subsidize private insurance plans for the same population, those at 138 percent of the poverty level.
Negron's plan and a bare-bones alternative by state Sen. Aaron Bean are on Tuesday's budget committee's agenda. Bean's plan is somewhat similar to a House plan developed by state Rep. Richard Corcoran, R-Land O'Lakes. Corcoran's plan is expected to come to the floor of the House this week.
Corcoran's plan would cover only about 115,000 uninsured Floridians -- parents of young children, and the disabled, whose income is less than 100 percent of the poverty level, or about $11,500 for one person. It would offer subsidies through the form of health-savings accounts, and would cost about $237 million a year from the state budget.
Some Republicans, including state Rep. Mike Fasano of New Port Richey, have already declared they are in favor of accepting Medicaid expansion. Fasano said that Corcoran's plan
As in Arkansas, the key to passage of the alternative Medicaid expansion is how many Republicans will go with the plan. The Tampa Bay Times says supporters are trying to pressure moderate Republicans to vote with the Democrats.
They say it would help big business avoid tax penalties and rescue hospitals from financial hardship -- not to mention the 1 million or more uninsured low-income workers who would gain health coverage.
The question is, how many Republican moderates are there in the Florida House? This week the answer could show up.
The struggle between the Senate and the House -- and between hard-core conservatives and moderates in the Florida Republican Party -- could go down to the wire. The session's last day is scheduled to be May 3.