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FL House to Senators: Vote ‘‘no’

By Gary Fineout and Christine Jordan Sexton
11/4/2009 © Health News Florida

Republicans in the Florida House, citing concerns that Medicaid costs are “unsustainable,” will ask the state’s two U.S senators to vote against health reform legislation pending in Congress.
House Majority Leader Adam Hasner asked Republicans to sign letters to Sens. George LeMieux and Bill Nelson during a late Tuesday afternoon briefing, where Republicans were warned about the ongoing surge in Medicaid enrollment and costs. Medicaid is the state and federal health care program that covers low-income families, the elderly and the disabled. 

House budget staff showed projections that Medicaid could increase from a 26 percent share of the state’s overall budget to as much as 36 percent in the next decade if trends from the past 12 years continue.

“What we are seeing here is unsustainable for the state,’’ said Rep. Denise Grimsley, R-Lake Placid, a registered nurse who is in charge of the House budget committee on health care spending. 

The 10-percent increase over a decade assumes that underlying medical costs, a driver in the Medicaid program, aren’t addressed.

Earlier, the Agency for Health Care Administration presented a forecast on the effects of federal health reform, saying it could cost the state more than $1 billion in Medicaid and put an additional 1.7 million people in the program if Congress passes the House version of health reform. The Senate version would have a smaller expansion and lower lower costs .

Some lawmakers, including some Republicans, said it’s premature to make projections since Congress hasn’t yet settled on a final bill and the House and Senate versions treat Medicaid quite differently.

"They are saying it is too expensive without knowing what it is," said House Democratic Leader Franklin Sands, D-Weston.

Nelson’s press secretary, Bryan Gulley, said he hasn’t seen the projections, but wonders if they account for the savings in emergency-room costs that would occur once the uninsured were covered. As of last year, Florida's uninsured population had risen to over 3.6 million. 

And consumer advocate Karen Woodall said it’s hypocritical for state lawmakers – who receive free health coverage for themselves and their families – to object to the expansion of Medicaid. 

“They don’t pay for their health care; we do,” said Woodall, who lobbies for the Florida Center for Fiscal and Economic Policy. 

While the number of people enrolled in Medicaid tends to dip when the economy is strong, medical expenses in the public program have grown steadily, as they have in private insurance. 

With Florida’s economy souring, the number of people relying on the state’s health care safety net has grown dramatically. The latest projections show that nearly 2.8 million Floridians are expected to be enrolled in Medicaid by next summer, a caseload increase of nearly 30 percent in two years.

Some of that growth was covered by an increase in the federal match rate funded through the stimulus. Instead of receiving about 55 cents for each Medicaid dollar, the state is receiving nearly 68 cents.
Enrollment has grown more rapidly than lawmakers had anticipated even last spring, and the nearly $18 billion program will likely be in a deficit by June of next year.

State lawmakers drawing up the budget for July 1, 2010 through June 30, 2011, are confronting the loss of federal stimulus money halfway through the budget year, on Dec. 31, unless Congress extends it. 

Hasner, R-Delray Beach, contends that Florida cannot afford federal health reform because it calls for dramatic expansions of Medicaid. While current versions of the legislation would cover 100 percent of the cost of expansion at first, states would be expected to take over some of that over time. 

Hasner said he’s concerned that the federal government would phase in that higher cost earlier than it’s now saying. He called health reform a “mandate from Washington that is going to create billions of dollars of budget obligations in Florida.” 

Both the Florida House and Senate are controlled by Republicans. At the federal level, there has been almost unanimous GOP opposition to the major initiatives of President Obama’s health overhaul.

AHCA’s forecast of a $1-billion increase in the cost of Medicaid if Congress passes health reform is based on the House version, which expands eligibility to a family living at or below 150 percent of the federal poverty level by 2015. It also increases pay to primary care physicians up to the level of Medicare rates. 

AHCA says the Senate measure would cost the state up to $716 million to implement and expand Medicaid in the state by 1.4 million people. It does not increase primary care physician rates to Medicare levels but it does enhance the amount of money the state receives from the federal government for Medicaid. 

Greg Mellowe with the health care advocacy group Florida CHAIN said Hasner was being short-sighted, since the state is likely to begin an economic recovery before Medicaid expansion takes effect. He called the state’s estimates “significantly inflated” because of “faulty assumptions.” 

Mellowe said it was wrong to assume that everyone who becomes eligible for Medicaid will enroll – something that’s never happened. He said changes in Medicaid eligibility would add some people the state already pays for through optional coverage programs such as Medically Needy.

“The concerns about bank-breaking are extremely myopic,’’ said Mellowe. 

Rep. Ed Homan, R-Tampa and a physician in charge of the House Health & Family Services Policy Council, said that while other parts of the health care reform bill are okay the Medicaid expansion “will be a killer.” 

“As many as 1 million more people will become eligible and we are hard pressed to afford to care for the 2.7 million currently enrolled,’’ said Homan, who did not attend the Tuesday briefing. 

However, some Republicans in the Legislature say lawmakers should wait to see how negotiations shape up in Congress before jumping into the fray. 

“I think any actions by us (are) premature at this point because we haven’t seen what’s going to pass,’’ said State Sen. Dennis Jones, R-Treasure Island, a chiropractor who sits on the Senate Health Regulation committee. 

--Gary Fineout and Christine Jordan Sexton are co-founders of