Fla. Senate Panel Rejects Medicaid Expansion
TALLAHASSEE, Fla. (AP) - A Florida Senate committee voted Monday against expanding Medicaid to roughly 1 million of the state's poorest under the federal health overhaul and instead proposed a voucher plan that would require patients to pay premiums and co-pays.
"This will be the beginning of a transformation of the entire Medicaid system," committee chair Sen. Joe Negron said. "My goal is that we will get out of the federal Medicaid system as we know it. Now we can't do that all at once, but we have an opportunity to begin that process."
Negron wants the state to create a basic health insurance plan for the expanded Medicaid population and require recipients to pay a sliding scale premium based on their income.
He suggested using Florida Healthy Kids, a managed care program that provides health insurance to low-income children, as the vehicle for delivering the new system. Some lawmakers, including Republican Sen. Aaron Bean of Fernandina Beach, also suggested using state funds to help patients pay those premiums.
"Could we ante up our own money to expand coverage but under our terms without creating the entitlement program that we can't or at least we've shown that we can never turn away or scale back?" Bean asked.
The Senate committee's rejection comes a week after a House panel also voted against Medicaid expansion, putting the GOP-controlled Legislature at odds with Gov. Rick Scott.
Scott wants to expand Medicaid for three years or as long as the federal government pays 100 percent of the bill, calling it a "compassionate" and "common sense" choice. The feds are slated to pay 90 percent after the three years.
In a prepared statement shortly after the Senate vote, Scott appeared willing to consider alternatives proposed by lawmakers: "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 healthcare law provides 100 percent federal funding."
Negron's proposal could save about $127 million a year compared to expansion of traditional Medicaid. He said Florida Healthy Kids is a respected program statewide that lives within its budgets, has plenty of doctor participation and is required to spend a certain amount of money on patient care to prevent administrative costs from ballooning.
It's not clear whether Negron's plan would win federal approval. States can charge co-pays and still get 100 percent reimbursement from the feds, but premiums are more complicated.
Lawmakers in both chambers have repeatedly expressed concerns that Medicaid is a broken system. Many fear the federal government will back out of its promise to pay, leaving the state on the hook for billions.
The straight party line vote, angered some Democrats who felt they weren't given time to consider alternative plans, including Negron's, which was presented at the last minute after weeks of hearings.
"We shouldn't force the Floridians who don't have adequate access health care to bear the brunt of our procrastination," said Sen. Chris Smith, D-Oakland Park.
If Florida expands Medicaid, state economists project the state would draw down more than $51 billion over the next decade and have to spend much less: nearly $5.5 billion. The federal government has agreed to pay for Medicaid expansion in its entirety for the first three years and cover 90 percent after that.
That's much more generous than the 50 percent match the state receives now to cover its current Medicaid population.
Despite Monday's Senate vote against traditional Medicaid expansion, several Democrats said the new proposal will still allow the state to receive billions of federal dollars and extend coverage to 1 million Floridians.
"A rose, by any other name, is still a rose," said Sen. Audrey Gibson of Jacksonville. "This move is long overdue and one the House would be wise to emulate."
The Medicaid expansion debate comes a month after Scott won a huge victory when federal health officials signaled they would likely grant permission for the state to move its entire Medicaid population into managed care as long as it fixed issues involving oversight and transparency.
The state spends about $21 billion a year on Medicaid to cover roughly 3 million residents - about half of them children. The bulk of the newly eligible group will be childless adults. It will be the first time the state has made Medicaid available to this group.
Health advocates also estimate about half a million of those eligible under Medicaid expansion are low-wage workers employed in the tourism and hospitality industries.
Hospitals lobbied lawmakers hard to expand Medicaid, saying they will be hit doubly hard if the state declines because the federal funding streams that hospitals rely on to pay for uninsured patients will end.
Hospital officials have estimated that Medicaid expansion would create about 54,000 new jobs, generate significant spending and reduce the amount of money spent covering uninsured patients by hospitals, insurers and taxpayers.
"Florida has been a donor state for too long. We have sent up too many dollars up to Washington and gotten nothing back," said Sen. Darren Soto, D-Kissimmee.
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