Would Health Reform Bill Help Florida?

Florida lawmakers have been wary of federal health reform in part because it uses Medicaid to cover many of the uninsured. They say the program is already busting the budget. But an expert on Medicaid policy says the expansion would be "good for Florida."

State legislative leaders haven’t had time to read the House bill released Thursday, which is nearly 2,000 pages. But they’ve previously objected to many of the items it contains, including the public plan offered as an option on the health-insurance exchange that will be set up, and the mandate that individuals and businesses get covered or face a penalty. 

Apart from ideological objections, lawmakers have a practical one: They're afraid that Florida will get socked with a big burden through the expansion of Medicaid, a joint federal-and-state program for the poor, elderly and disabled. 

Even the current caseload, absent any expansion, will cost more this coming year than Florida can afford, lawmakers said when they heard the latest report on Monday. Enrollment is projected to reach 2.77 million by next July, an increase of more than 600,000 since the summer of 2008.

“I don't know anybody in the Florida Senate so hard-hearted that they would not want to provide more care and services to a poor person or a nearly poor person who is uninsured, especially in this economy,” Sen. Don Gaetz, R-Niceville, said.  "It is not a question of will, and it is not a question of want, it is a question of can. The problem is, we have to make sure the checks cash.” 

Despite the recent increase in caseload, Medicaid eligibility rules are so narrow that millions of uninsured Floridians don't qualify. According to recent reports, more than 3.6 million Floridians were uninsured last year, including almost 800,000 children.

In Congress, the Senate version of health reform would raise the income eligibility level for Medicaid to 133 percent of the federal poverty level – about $30,000 a year for a family of four-- which means that about half the uninsured children in Florida could be covered under Medicaid.

The House version would raise the income level to 150 percent of the federal poverty level, so even more would be covered, although the estimates aren’t in yet.

The expansion would begin in 2013, and it would be entirely paid for by federal funds for the first two years. After that, the federal share for the new recipients would drop to 91 percent.

But Florida lawmakers don’t necessarily believe that level will be sustained. They point to the expansion of Medicaid last year that was entirely covered by the federal stimulus; it’s scheduled to plummet at the end of 2010, leaving Florida with a loss of $1.8 billion a year.

“We’re already a donor state,” said Sen. Mike Fasano, R-Tampa. "For every dollar Florida taxpayers send to Washington, we get 85 or 90 cents back.”” 

On the other hand, say supporters of the bills, lawmakers need to look at the bright side of Medicaid expansion. The federal government payments "will bring money into the Florida economy at a time when we need it," says health consultant Brady Augustine of Tallahassee. “This will be good for Florida."

By 2015, when Florida has to pay that 9 percent share, he says, the economy will have recovered enough to cover the cost. Meanwhile, a significant number of formerly uninsured Floridians will have been getting health coverage via Medicaid, the least expensive plan around. 

Another good feature of the House bill, he said, is that it would require Medicaid HMOs to spend at least 85 cents of every dollar they get from taxpayers on health care for their members. Currently, Florida Medicaid requires that only for mental health and substance abuse.