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In Standoff Over Medicaid, Will Senate Blink?

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.

State Sen. Joe Negron's Healthy Florida plan, which would use federal funds to cover low-income uninsured,  has run into a wall:the Florida House. Rather than try to bulldoze the wall, Senate leaders say they're searching for middle ground.

Negron hinted to the Palm Beach Post on Tuesday that the solution is a "hybrid" of his plan and the one being pushed by the House.  But such a hybrid might  not qualify for federal funds under the Affordable Care Act.

Today, the Senate Appropriations Committee is scheduled to take up the Negron plan, called Healthy Florida, and one by Sen. Aaron Bean.  Bean's plan bears some resemblance to the House plan in that it too rejects federal funds and would offer bare-bones plans.

Negron did not say whether a hybrid might be introduced at today's hearing.

Negron's plan would accept an estimated $51 billion in federal funds over 10 years -- at no net cost to the state, by the latest estimates -- to cover more than 1 million uninsured people who have incomes under 138 percent of the poverty level.

The House plan, Florida Health Choices Plus, would provide only bare-bones coverage to about one-tenth as many people, 115,000. The House would accept no federal funds at all, financing the plan with new state spending of $237 million a year.

Negron appears to be following orders from Senate President Don Gaetz, who told the Tampa Bay Times a middle ground might be one that covers fewer people -- the most "vulnerable."

In House-speak, the vulnerable are uninsured disabled people and working parents who have children under 18. House Speaker Will Weatherford has said he opposes helping "able-bodied" adults.

Gaetz told the Times that he wants to break the standoff to avoid a special session later in the year. The federal funds are available beginning Jan. 1: 100 percent of the cost for the expansion population for the first three years, then tapering to 90 percent by the year 2020, and remaining at that level.

This is a much higher percentage of the joint funding than states currently enjoy. While it varies by state and by the type of patient, it currently averages about 58 percent federal funding in Florida.

Gaetz's apparent decision to reduce the number of uninsured he is willing to cover in order to get the House's agreement could result in Florida receiving no funds from the federal Department of Health and Human Services.

HHS Secretary Kathleen Sebelius has said in the past that states have to take all of the uninsured who are covered under the Affordable Care Act in order to qualify for the funds.

It is unclear whether Florida is prepared to go back to court over the ACA. The state led more than two dozen others in a challenge to the law's constitutionality. Last year the Supreme Court upheld most of the law, with one exception. It said the states get to decide whether to participate in Medicaid expansion.

That decision set up the debate that led to the current standoff. While both the House and Senate committees studying ACA implementation rejected expansion of Medicaid, the Negron plan was seen as an alternative that accomplished the same goals and thus would likely receive federal approval.

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.