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Senate Panel Says No to Medicaid Expansion, Wants 'Florida Plan'

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

The Senate's special committee on the Affordable Care Act voted along party lines Monday to reject Medicaid expansion, with members saying they want to develop a Florida-specific plan. The vote was 7 to 4.

Sen. Joe Negron, chairman, led the charge of the Republican majority, saying, "I oppose the Washington plan. I want a Florida plan. I think we have the opportunity to build a better system than the one Washington created."

Negron offered an alternative -- which members of the committee dubbed the "Negron Plan" -- that would offer 1 million low-income uninsured in Florida a basic plan tied to a health-reimbursement account.

At first blush, it appears that the vote means Florida is turning down federal funds of between $50 and 60 million over the next decade -- money that the Affordable Care Act would provide if Florida expanded the Medicaid program to those with incomes of under 138 percent of poverty. 

But Negron seemed confident that such a waiver might be forthcoming. He noted that the Obama administration has granted waivers to certain other states that want to tweak the federal plan.

Negron's vision is to set the alternative plan up through an existing public-private program, Florida Healthy Kids. It uses public funds to offer parents HMO coverage for children on a sliding scale and is generally viewed as popular by both health-care providers and members, he said.

"You'd be uniting parents with their children in one plan; we'd have a family plan," Negron said. "We're rejecting the Washington plan, adopting a Florida plan."

Rep. Aaron Bean, another Republican member of the committee, said he intends to come up with his own plan. He did not say much about it, but presumably he wants to use a different vehicle -- Florida Healthy Choices, a small-employer insurance exchange which he designed while serving as House Health Appropriations Chair before moving to the Senate. 

Other Republican members congratulated Negron for coming up with an alternative to Medicaid, calling the joint federal and state program "defective" and "broken." 

Even though they backed the Medicaid expansion, several Democrats thanked Negron for his efforts to come up with a solution for the state's poorest uninsured adults. They pointedly remarked that it was more than the House committee had done last Monday when it rejected Medicaid expansion, also on a party-line vote.

The five points of the Negron Plan, as he outlined them, were:

--Medicaid would not be the vehicle used for the expansion of coverage. Negron proposed using Florida Healthy Kids, which is efficient and well-managed enough to save money over traditional Medicaid, he said.

By going through Healthy Kids, Negron estimated the savings at 4.5 percent, or about $127 million a year.

--There would be a "benchmark" plan, a typical, average plan. Everyone would pay something toward it, on a sliding scale based on their incomes. The co-pay for an emergency room visit could be as little as $3.80, Negron said.

"Nobody would be denied care, but we would have the expectation that everyone would participate," he said.

--The plans would be attached to health reimbursement accounts, or HRAs, which would accrue money for healthy behaviors -- money that could be used to pay the patient's share of bills.

--There would be individual plans available, in addition to family plans, as there are in the private market.

--The "Florida Plan" would eventually replace the traditional Medicaid program, which now covers about 3.3 million in the state.

"This will be the beginning of a transformation," said Negron. "My goal is we get out of the federal Medicaid system as we know it."

The income limits for participation in the expanded Medicaid program -- or the Florida alternative, if the federal government will allow it -- are roughly $26,000 per year for a family of three or about $14,000 for an individual.

House Speaker Will Weatherford released a statement applauding the vote against Medicaid expansion. "Like the House, the committee gathered the facts and decided that Washington’s inflexible approach to force Florida to take a 'one-size fits all' policy choice is not in our state’s best interest."

Weatherford said he will work with Senate President Don Gaetz to explore Medicaid alternatives "that will strengthen the safety net while also ensuring that we do not put future funding for our schools, public safety and protection of our beaches and springs at risk.”

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.