Florida House Votes Down Senate Medicaid Plan Leaving Florida with Large Coverage Gap

Today the Florida House voted down the Senate’s Florida Health Insurance Affordability Exchange plan that would have accepted federal Medicaid funds. The House’s rejection of the Senate plan follows a strong bipartisan vote in that chamber in favor earlier this week of 33-3. Both chambers have large Republican majorities. An estimated 669,000 Floridians will remain uninsured in the coverage gap as a result of the House’s action.

From my perspective, the Senate plan wasn’t perfect and raised some policy concerns, but the concerns expressed by House Republicans were largely focused on tired and weak arguments that the federal matching funds would decline or go away and that state costs were likely to be significant. These arguments persisted even though the legislature’s own economist from the Office of Economic and Demographic Research Amy Baker had issued an analysis showing the Senate plan would save the state money for many years to come.

And as we have blogged about before, changing the Medicaid matching rate virtually never happens and would take an act of Congress.

Florida’s Medicaid fight has been full of twists and turns over the past few months including a dramatic end to the regular session when the House walked out early as budget negotiations came to a standstill over the Medicaid issue. As I have said for many months now, the question of extending Medicaid coverage is no longer a partisan one but rather a fight within the Republican party between more pragmatic Republicans, who recognize a good economic deal when they see it, and the extreme ideological wing of the party which continues to oppose “Obamacare” at all costs. Nowhere has this dichotomy been more on display than in Florida. And nowhere – except for Texas – does this ideological extremism exact a greater toll on the large numbers of Floridians who will remain uninsured.

Interestingly, Republican legislators in nearby Louisiana took a different and united path this week with both Republican-led legislative bodies voting for a resolution to authorize a provider tax to pay for the state’s share should a future Governor in that state pursue Medicaid funding. Current Republican Governor and Presidential-hopeful Bobby Jindal has staunchly opposed going down this path, but he will be out of office by the end of the year, and all of the major candidates to replace him, from both parties, have signaled they will consider accepting the Medicaid funds.

A lead supporting actor in the Florida drama has been the state’s Low-Income Pool (LIP), a fund used to support uncompensated and undercompensated care costs through the state’s Section 1115 Medicaid waiver. The federal government has indicated that LIP will be cut by 55% for the coming state fiscal year, and by 75% in the next state fiscal year. Florida’s legislature still must grapple with this reality and it looks like legislators will plug the hole, at least in the short term, by throwing in state general revenue made possible by a considerable surplus this year. But we will have to stay tuned on how that works out. The problem will be worse next year –and it won’t go away by kicking the can down the road.

As the debate closed, Senate President Andy Gardiner said “I may not be the presiding officer when this proposal finally makes it but this is the future. It just is.” Improved health outcomes and health insurance coverage for almost ¾ of a million uninsured Floridians and state budget savings strike me as a winning combination. But apparently Speaker Crisafulli and his allies don’t agree.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.

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