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FL may resist Medicaid expansion based on ruling

Florida elected officials have been griping about the forced expansion of Medicaid under the Affordable Care Act ever since it was passed in 2010. Today's Supreme Court decision appears to give them an out.

The state challenged the constitutionality of the law on two grounds -- the individual mandate to buy health insurance and the requirement that states expand their Medicaid programs.

The 5-4 ruling upheld Congress' right to pass the individual mandate -- which charges a penalty to those who don't obtain coverage -- under its taxing ability. But the court overturned Section 4, the Medicaid expansion.

It violates the Constitution by threatening states with the loss of their existing Medicaid funding if they decline to comply with the expansion, Chief Justice John Roberts ruled.

The current Medicaid program is jointly funded by the federal government and the states; this year, the state's share is about 44 percent, according to State Health Facts. The program covers certain categories of uninsured low-income people, including children, pregnant women, the blind, elderly and disabled.

The ACA increased the number of individuals that the states had to cover under Medicaid up to 133 percent of the federal poverty level. While the federal government said it would cover all of the cost of the increase for the new population for the first two years and then a majority of the cost until the end of the decade, when it rests at 90 percent, state officials blanched.

They said they feared the ACA's requirement to obtain health coverage would scoop up individuals who qualified for Medicaid but never signed up for it. And that new population would be paid for at the old rate, which could cost state taxpayers more than $100 million a year, they estimated.

Medicaid officials have estimated that the cost of expanding the program could altogether add $1 billion to its cost. However, consumer advocates say that there are offsetting costs by reducing the number of uninsured low-income people who get emergency-room care.

Of Florida's estimated 4 million uninsured, about 1.2 million would qualify for Medicaid under the new rules if Florida chooses to go along with the expansion. About 3 million are already enrolled in Medicaid in the state, and the program accounts for more than $21 billion -- almost 1/3 of the state budget.

By noon, some in Tallahassee were already predicting that Florida would opt out, the Palm Beach Post reported. 

--Health News Florida is an independent online publication dedicated to journalism in the public interest. Contact Editor Carol Gentry at 727-410-3266 or by e-mail.


Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.