Medicaid Expansion Is Rejected in Florida

Published: March 11, 2013 - New York Times

MIAMI — Rebuffing Gov. Rick Scott’s support of Medicaid expansion, a Florida Senate committee on Monday rejected the idea, all but ending the possibility that the state would add more poor people to Medicaid rolls.

But the Senate panel debating the expansion proposed a compromise: to accept the federal money but use it to put low-income people into private insurance plans. Accepting the money would please the governor and a number of Floridians, while steering people away from Medicaid, which many lawmakers and residents view as troubled.

The committee vote to reject a Medicaid expansion under President Obama’s health care overhaul was 7 to 4, with Democrats voting for the expansion.

Last week, a Florida House committee voted to reject Medicaid expansion altogether, saying that the system was broken and that adding people to the rolls would cost taxpayers too much money in the long run. The House speaker, Will Weatherford, a Republican, said it was the wrong approach, calling it a “dangerous path.”

From the start, Mr. Scott knew it would be difficult for the Florida Legislature to embrace Medicaid expansion, even for only three years, which is what he proposed. The governor had staked his political career on derailing what he calls “Obamacare,” and his abrupt reversal did not endear him to conservatives in Florida or in the Legislature.

Last week, he made it clear he was not going to lobby the Legislature on Medicaid, preferring to use his influence to push through raises for teachers and eliminate a manufacturing sales tax.

“I am confident that the Legislature will do the right thing and find a way to protect taxpayers and the uninsured in our state while the new health care law provides 100 percent funding,” Mr. Scott said in a statement Monday after the vote.

A Senate committee will convene to develop a plan that would use federal dollars under the law to expand Florida Healthy Kids, a well-established, well-liked health care exchange for low-income children. The proposal would allow the one million uninsured adults who qualify under the health care law to join and choose among various insurance plans. They would pay on a sliding scale, depending on income.

“I think it’s important for us to say no to having Washington tell us to expand our Medicaid program,” said Senator Joe Negron, the Republican chairman of the Senate Select Committee on Patient Protection and Affordable Care Act, who made the Healthy Kids proposal.

But, he said, the committee still hopes to address the larger problem. “We want to try to find a creative way to help people, empower people to have their own private health insurance but not put them into the Medicaid program,” he said.

Democrats said they were pleased that the Senate panel chose to accept the money, even if it meant taking a different approach. “A rose, by any other name, is still a rose,” said Senator Audrey Gibson, a Democrat on the panel. “This move is long overdue and one the House would be wise to emulate.”

It is unclear whether the Obama administration would accept such a proposal. Several states, including Arkansas, Indiana and Ohio, are exploring using private insurers to enroll uninsured patients. The administration recently agreed to a proposal by the Democratic governor of Arkansas, Mike Beebe, who sought to reject Medicaid expansion and use federal money to buy private health insurance for its uninsured residents who qualify.

The Senate proposal would also have to clear the House, which is working on its own proposal and has taken a more conservative line.