After a passionate debate, the Florida Senate passed a bill Wednesday that would let a half million people use billions in federal dollars to buy health insurance, and added new measures to address criticism from the House, chiefly that the program would end in three years.
The revised version of the Florida Health Insurance Affordability Exchange, or FHIX, today heads to the floor of the Florida House, which is unlikely to back the proposal.
A majority of Senate Republicans supported the controversial health care bill, by a 33-3 vote. Earlier this week, a state economist said the plan would save the state money. A top state health official warned it was unclear whether more or less people would gain coverage under the bill.
The Senate addressed some of those concerns by adding requirements to end the program in three years so the state isn't locked in. Senators also folded in the state's most vulnerable sick population, known as the medically needy program, strengthened a work requirement and ensured that premiums would not rise for those in the Healthy Kids insurance program.
The bill faces an unlikely passage in the House even though sponsor Sen. Aaron Bean said it's projected to save the state $547 million and draw down over $18 billion from the federal government. About 800,000 Floridians are eligible, but an estimated 300,000 to 400,000 would not meet the work or school requirement and would not get coverage, he said. Recipients would also be required to pay small premiums.
State health officials worked late Tuesday night with the Senate to address potential problems with the bill, but Agency for Health Care Administration Secretary Elizabeth Dudek said in a statement Wednesday "we still have many concerns" and are uncertain whether the plan "will be able to provide more Floridians with health coverage."
Gov. Rick Scott and House Republicans also remain adamantly opposed to taking any federal money tied to so-called Obamacare. The Obama administration would pay the entire expansion bill for the first few years and 90 percent after that, but the governor said it would still cost Floridians $5 billion over 10 years.
The debate tore apart the Legislature's regular session, with lawmakers unable to agree on a budget. The House adjourned three days early in late April, prompting the Legislature to return this week for a special session.
The House and the governor want the Obama administration to extend a hospital fund known as the low-income pool. But the Senate, the Obama administration and hospital groups instead want the state to expand Medicaid, arguing it's more efficient to use federal funds to give people insurance than to pay hospitals for caring for the uninsured retroactively.
"This debate has become so rancorous and so fierce and so divisive," said Republican Sen. Don Gaetz, who noted there is a split in his own family. His son, Rep. Matt Gaetz, has voiced opposition to the Senate plan.
"Let's not mimic the do-nothing Washington that we despise. Let's work out our differences ... it is not too late to rise to our finest hour," the senior Gaetz said.
At one point during the regular session, House Republicans were heard behind closed doors encouraging each other to hold strong in their opposition even if it meant a special session.
"The only thing I've heard on the other side is politics, misrepresentation and scare tactics," Sen. Darren Soto said of House Republicans.
Sen. Jeff Brandes, a St. Petersburg Republican who voted no, said he did not think it was "responsible" to grow the number of people who are given health care coverage. He also said Florida should not approve a program that would require the federal government to continue to borrow money.
"There isn't some magical pot of money," Brandes said. "There's no Confederate gold underneath the federal Capitol."
Senate President Andy Gardiner and supporters repeatedly stressed that the proposal does not expand Medicaid, but allows consumers to purchase private insurance — something the governor strongly supported in the regular Medicaid program.
"If we were talking about traditional Medicaid expansion here I would be completely against it," said Sen. Wilton Simpson.
The Obama administration agreed to extend the hospital funds but at only half the amount the state received last year. The governor instead wants to funnel money from public hospitals to for-profit hospitals and has said it's not necessary to use state funds to fill the gap, but local officials and hospitals are opposed to that plan.
It's unclear how legislators will balance the rest of the state budget and how much state money will be available for Scott's top priorities — tax cuts and boosting money on public schools.
