The Florida Medical Association, one of Tallahassee’s most influential lobby groups, sat out last year’s legislative nail-biter over Medicaid expansion, saving its firepower for pocketbook issues, such as making it harder for patients to sue and keeping non-physicians off their turf.
But now an FMA advisory committee that studied the issue is backing Medicaid expansion, which would bring in federal funds to cover the low-income uninsured, according to two doctors who have seen the documents. A resolution from that committee goes to the FMA Board of Governors later this week.
“I think the chances (of passage) are very good,” said obstetrician-gynecologist Aaron Elkin, author of the resolution and chairman of the Broward County Medical Association. “I don’t see any reason it would not be adopted.”
Elkin's resolution goes beyond a simple plea that Florida take the money, estimated at $51 billion over 10 years. It predicates the FMA support for the Medicaid expansion on legislative action fixing the pay for doctors treating Medicaid patients at an amount equal to that for Medicare, the federal program for seniors and the disabled.
"The Council’s recommendation to the Board is that we support Medicaid expansion ONLY if Medicaid rates are raised to Medicare levels for ALL physicians," FMA spokeswoman Erin Vansickle wrote to Health News Florida in an e-mail. "There will not be a recommendation that we just support Medicaid expansion as is."
If the Board agrees and uses its power to push for Medicaid expansion, the issue still faces opposition. Last year, a variation of Medicaid expansion passed the Florida Senate, but died in the House. And judging from remarks by House Speaker Will Weatherford, the issue may die this year, too, without a massive push.
At last summer’s FMA House of Delegates conference, which was closed to the press, a sharp split developed over resolutions to back Medicaid expansion, say several who were there. Internist Owen Linder of Safety Harbor, who proposed one of the pro-expansion resolutions, says it had support of about 40 percent of the delegates. The majority voted to send the matter off for further study.
The split reflects a difference of philosophy between primary-care physicians -- pediatricians, family practitioners, internists, and obstetricians -- and specialists, those who tend to make more money and hold more power in organized medicine.
“I haven’t talked to a primary care doctor who thinks (Medicaid expansion) is a bad idea,” Linder said. “I haven’t talked to a specialist who thinks it’s a good idea.”
The FMA already has other issues on its legislative agenda. It is expected to put its muscle into “scope of practice,” as nurse practitioners and others seek more independence from physicians’ supervision. Critics of the FMA regard this as a turf battle, while FMA says it is chiefly concerned about public safety.
To accomplish its legislative goals, the FMA has to stay on the good side of House Republican leaders, the same group that killed Medicaid expansion last year. If it came down to a decision over which was more important, pocketbook issues or providing preventive care for the poor, Linder says it should be no contest.
“Nothing the FMA is trying to do is worth the lives of 1 million people,” said Linder, whose resolution would have simply expressed support for Medicaid expansion, without the language about a Medicaid pay raise for doctors.
Dr. Mark Rubenstein of Jupiter is scheduled to present the resolution to the Board of Governors, who will meet at Amelia Island this weekend. Rubenstein chaired the FMA advisory committee, the Council on Medical Services and Health Care Delivery Innovation, which considered both Linder's and Elkin's resolutions. Elkin's is the one that will be presented.
Rubenstein said he does not know what, if anything, the Board of Governors will do. And if the Board adopts the resolution, it doesn't mean the legislature will go along, he said.
"This is a very serious political issue," Rubenstein said. "It affects physicians and access to care."
Medicaid expansion is a key part of the Affordable Care Act. As originally written, expansion would cover families who have incomes too low to qualify for subsidized enrollment on the federal Health Insurance Marketplace at Healthcare.gov. Expanding Medicaid would provide coverage for about 1 million of Florida’s 4 million uninsured, analysts estimate.
But in ruling the health law constitutional in 2012, the U.S. Supreme Court said individual states had the option to expand Medicaid, the health coverage program for the poor. Medicaid is jointly funded and operated by the states and federal government.
The American Medical Association and most medical societies in other states have backed the Medicaid expansion, or some variation of it. Even the Texas Medical Association is pushing its Republican governor and legislature for passage, so far without success.
So far, a majority of states – including some with Republican governors and legislative majorities – have decided to take advantage of expansion and the federal government’s offer to cover the entire cost of expansion for three years and at least 90 percent after that.
During Florida’s 2013 Legislative session, Florida Gov. Rick Scott came out in favor of taking the federal money, and several studies showed it would boost the economy. A plan sponsored by Sen. Joe Negron, R-Stuart, won almost unanimous support in that body.
Weatherford gave a variety of reasons for not taking federal funds, including a distrust for the government’s ability to continue paying for its portion of Medicaid. With the 2014 legislative session scheduled to start March 5, there is no sign from Weatherford he has changed his mind.
Health News Florida is part of WUSF Public Media. Contact Editor Carol Gentry at 813-974-8629 (desk) or e-mail at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.
