State health policy experts said Thursday prospects for expanding Medicaid in the Legislature this year remain dim because of unwillingness in the leadership and possibly fatal flaws in the two leading proposals. And those experts warn another refusal could come with a stunning economic cost for Florida.
House Speaker Steve Crisafulli says he has no plan to consider expanding Medicaid to cover the million Floridians who currently don’t qualify but are still too poor for Obamacare insurance. Because they get their health care in emergency rooms and usually can't pay for it, that's already costly to people who have insurance.
"Those with insurance are paying on average $1,200 a year more to cover those costs," said Deirdre McNabb, president of the Florida League of Women Voters.
But most of the hospital reimbursements for uncompensated care come from the federal government under two programs that are scheduled to end June 30 whether Medicaid is expanded or not. Citing a three-year study she did at Florida Legal Services, Miami attorney Charlotte Cassel of Florida Legal Services said that makes Medicaid a virtual no-brainer.
"Florida stands to lose up to two billion but would gain up to five billion, if the expansion were accepted, per year,"Casselsaid.
Florida hospitals could lose an estimated $22.5 billion a year if the hospital subsidies go away with no Medicaid expansion in place.
But expanding Medicaid with federal aid could add $66 billion to the Florida economy through 2022. Under the expansion plan, the federal government would provide 100 percent of the funding through 2016 with a gradual decline thereafter to 90 percent by 2020.
An expressed concern that the feds would renege and stick the state with the entire bill appears to have motivated the Republican-led Legislature to stay out of the program.
Pro-expansion pressure from the business community could make a difference in Tallahassee but both of the business proposals, one from Associated Industries of Florida and the other from the state Chamber of Commerce, come with work or job training requirements.
Joan Alker at the Georgetown Center for Children and Families says that could be a deal breaker with the federal Centers for Medicare and Medicaid Services, where the rules are made.
"What CMS has clearly said no to is the idea of linking your Medicaid coverage to a requirement that somebody work," Alker said, noting that a work requirement in Indiana's proposed expansion plan has been exchanged for work and training "referrals."
Senate President Andy Gardiner says he's open to a discussion of expanding Medicaid in the session that begins March 3.
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