State Sen. Joe Negron's "Healthy Florida" plan, officially launched without dissent Thursday by the Senate Appropriations Committee, has already attracted support from a broad swath of industries and leaders of both political parties.
Republicans and Democrats on the panel said they see it as a creative way to solve both a health-access problem and a political dilemma: How to cover 1 million low-income uninsured adults, using federal Medicaid-expansion funds tied to the Affordable Care Act, without actually expanding Medicaid, a program that has become politically toxic in the GOP?
Negron's answer: Create a separate plan that would be managed not by the government but by a popular non-profit, the Florida Healthy Kids Corp. And while billions of dollars would flow to it through the federal Medicaid program, the new plan would not carry that name.
"We're not putting one more citizen of Florida into the Medicaid program," declared Negron, chairman of the Appropriations Committee.
Members rushed to praise him, taking swipes at Washington and the Florida House in the process.
"I want to thank Sen. Negron for offering up a solution, for not just saying no," said Sen. Jeremy Ring, a Broward Democrat.
Orlando Republican Sen. Andy Gardiner agreed. "Do we just throw our hands up and say we're not going to accept any federal dollars? ....We have to look at what's the responsible thing to do."
"We've got to find a plan that we can all say yes to," said Sen. Aaron Bean, R-Fernandina Beach. "I think the Negron plan is something we can all move forward on."
A critic from the audience, who said the target population should "stand on their own two feet," drew an emotional response from Negron. He offered a list of people who work long, hard hours for modest incomes, including teachers, nurse's aides, and waiters. Some of those he has met even work two jobs, he said, and it's not their fault that they don't make enough money to buy health insurance.
"I was brought up to respect people who work, no matter what kind of work they do," he said. "People who receive their health care through Medicaid are honorable people of dignity and respect, sovereign citizens of this country. They pay taxes, they go to work every day and they deserve to be treated with the same dignity and respect as people with private insurance."
A great deal of money is at stake, estimated at more than $50 billion over 10 years. Both business and consumer groups want the state to accept it, rather than turn it down, as House leaders have suggested -- a move that would result in Floridians' tax dollars flowing to other states.
"I really want to thank you for bringing our money back to Florida," said Sen. Gwen Margolis, a Democrat on the Appropriations Committee. "We certainly pay enough in taxes to find a way to get our money returned."
Business interests have backed the solution as enthusiastically as consumer activists, because they have a lot of money on the line. Hospitals would be rescued from a fiscal rupture, as the Affordable Care Act takes away some of the subsidies they receive for free care. Employers would avoid penalties triggered by their low-income workers seeking federally subsidized coverage.
As Health News Florida reported last week, the Obama administration signaled it's receptive to the plan. Its former nemesis, Florida Gov. Rick Scott, has embraced the idea.
Everyone's singing from the same songbook on Senate Bill 7038 except the Florida House of Representatives. Its leaders have declared they won't accept federal money, even if it means forfeiting billions of dollars to other states.
As the bill describes the program, the non-profit that enrolls low-income children in health plans using a combination of federal and state funds would separately mange the Healthy Florida program for low-income adults. It would find good-quality plans that offer individual and family coverage and provide subsidies to cover the premiums, with enrollees paying a small amount for each service out of pocket.
Plans would be linked to bank accounts, where rewards for healthy behavior could be saved for co-pays or drugstore items. (For more details, see the legislative staff summary and analysis.)
The plan would require approval from the Department of Health and Human Services, but that should be quick because it was crafted specifically to comply with federal rules for alternative Medicaid programs, Negron said.
The state would have to get the plan to HHS by June 14, with an eye toward winning approval in time to start enrollment Oct. 1.
"By Jan. 1, a million of our fellow citizens who go to work every day and do the right thing will have health insurance," Negron said.