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Medicaid Expansion Cost? Still a Guess

The capitol buildings in Tallahassee
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

As legislative hearings continue on the cost vs. benefit of Medicaid expansion – a decision Florida must make in the coming session -- only a few things are clear:

--No one knows for sure whether the expansion to approximately 1 million uninsured Floridians whose incomes are below 138 percent of the federal poverty level will end up being a net plus to the state – since the federal government is putting up over $26 billion over 10 years – or a net minus. A study is available to fit every opinion.

--The bottom line on studies depends on the assumptions that are being made. The most infamous example of that was Gov. Rick Scott, who assumed that the federal government would not come through with the money that the law calls for.  The state's forecast was cut to about $3 billion-to-$5 billion after Health News Floridareported on it.

At a series of hearings held by House and Senate committees on the Affordable Care Act, those testifying for conservative groups predict the sky will fall, budget-wise, if Florida expands Medicaid, despite the federal funds.  They note that this population tends to be older than the current population of non-disabled adults in Medicaid, most of whom are mothers with young children.

Those testifying for liberal groups predict an economic boom, citing the ripple effect on the economy of federal dollars coming into the state.

As for the neutrals – led by the state’s chief economist, Amy Baker –they say they need more time.  She  told the House committee on Monday that the budget commission will meet to come up with a forecast on March 1. The Senate's ACA committee plans to hear her presentation on March 4, the day before the session begins.

--Very few of those who will be affected by the Legislature’s vote on whether to expand Medicaid will have been heard from during the committees’ deliberations (although a petition signed by 10,000 people in favor of the expansion was presented at Monday's hearing.)

--If the Legislature decides to go ahead with Medicaid expansion, it will include a "trigger." That's a clause that says if the federal government stops sending the money it promised, the extra Medicaid enrollees will be dropped. Several states that have been wary of future costs have already adopted a trigger.

--Dollars dominate the discussion during the hearings. Maybe the lawmakers and witnesses do care in their heart of hearts whether people have access to health care – they probably do – but they seldom mention it.

Tommy Inzina, a top executive for BayCare Health System in Tampa Bay, admitted as much under questioning from a legislator. “It’s all about the money,” he conceded.

“There’s just too much money on the table …to pass up,” echoed Mark Robitaille, president and CEO of Martin Health System.

To see the studies presented on Monday, go to the meeting packet on committee’s website (warning – it’s 192 pages).

To see more coverage, see Jim Saunders’ story from News Service of Florida.

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.