Not what we want to think about just following sine die; but a perfect storm approaches in 2014: the deadline is near for when Americans will be required to have qualified health coverage or else face penalties, the clock is ticking under which Florida could draw down $1 billion in federal funds for that year to expand health care coverage for the uninsured, and Florida’s gubernatorial election will in no small part hinge on how this is all handled.
For good reasons and abundant other distractions, no consensus was reached during the 2013 legislative session. But waiting for the 2014 session is not an acceptable fall back, politically or otherwise.
There are more than enough reasons to dislike and distrust the terms set by the federal reforms — but as Gov. Rick Scott deliberated, this is the law of the land and with real lives and colossal dollars on the line, the choice is clear to do… something.
States cannot be compelled, according to the US Supreme Court ruling, to expand Medicaid; just the same as states cannot be compelled to set certain speed limits. But the funding attached to these suggested policies — hate how they came to be — are worth bargaining for.
At least that’s what people will feel when they hear from candidate robocalls in 2014 that they were deprived of health care coverage (even if only for a year or two) because their leadership was too principled to budge.
Florida isn’t the only state to be in this tight spot.
At last count, according to Avalere Health, 26 states may reject Medicaid expansion, and at least three of them resemble Florida in having governors willing to accept federal funding with legislatures that are not.
What the Avalere map does not show, however, is how many of the 26 states rejecting Medicaid expansion have come up with viable alternatives that qualify them for federal funding; or how many already have programs in place that provide comparable coverage to the uninsured.
When Gov. Scott initially came out in support of expanded Medicaid coverage, signs pointed toward Florida joining the 20 states and DC who have committed to doing so. This prediction changed as legislative session drew to a close with no consensus in sight.
Both sides of the aisle have offered ‘solutions’ that build upon troubled programs: Democrats, with the push to expand Medicaid — a program that already threatens to eat the state budget whole; and some Republicans, with the push to pump more funds into Florida Health Choices — a program that was created in 2008 but has yet to enroll anyone.
The Florida Senate backed a plan, forwarded by Sen. Joe Negron, which would have used the successful Healthy Kids model to meet PPACA criteria, covering Floridians who fall below 138 percent of the FPL, and draw down federal funding in doing so.
This “Healthy Florida” proposal even came with a catch: it would become defunct at any point that federal funding dipped below certain thresholds, thus eliminating risk to Florida’s budget and quelling the wholly justified fear that the promised federal dollars simply do not exist.
Sen. President Don Gaetz predicted early that this proposal would be dead-on-arrival in the House, but pointed fingers at the “federal straightjacket ” imposed on states by HHS secretary Kathleen Sebelius and the administration’s all or nothing approach to its approval of state programs. While HHS has expressed it would consider alternatives to Medicaid expansion, it will only do so for state programs that cover the entire eligible population, not just portions of it.
The political landscape surrounding this issue includes more than a few million uninsured constituents. Adding to the mix of interests groups in support of Medicaid expansion or a reasonable alternative are hospitals, health insurers, Chambers of Commerce, Associated Industries, and many health care providers. Much like Gov. Scott, many of these groups were staunchly opposed to the mandates passed under federal reform.
It is unsurprising that regular session fell short of a solution, and if anything this reflects that House and Senate leadership take health coverage expansion seriously enough to prevent shoddy laws from being passed on the fly. With, in recent days, PPACA being referred to as a “train wreck” by even its allies, the worst case scenario would be Florida jumping on board without enough attention to detail.
All of which suggests that this issue is precisely what special sessions are for: a limited focus on a complex, consequence-laden cause.
Gov. Scott was among the more public and effective opponents to “Obamacare” and he could apply this same resolve via special session toward finding a state solution that rebukes aspects of PPACA, expands coverage regardless, and gains federal support and funding to do so.
Lest Florida’s notable progress on the jobs front get lost beneath a pile of attack mail showing how these same workers can’t access health care.
Via Karen Cyphers, PhD, is a public policy consultant, researcher, and mother to three daughters.
