With Republicans showing no signs of wavering, the House this week could take up a plan that leaders describe as a “free market” alternative to expanding Medicaid under the federal Affordable Care Act.
The House Appropriations Committee voted along party lines Friday to reject Medicaid expansion and approve the alternative plan, which would provide $2,000 state subsidies to help targeted groups of low-income people buy private health coverage.
The vote appeared to underscore differences between the House and Senate as they head into the final two weeks of the legislative session and try to reach agreement on a way to help more people get health care.
Senate Republicans also have rejected expanding Medicaid, but many are backing a plan that would offer private health insurance to hundreds of thousands of low-income people — a plan that would rely on federal money that otherwise would go to Medicaid expansion.
Republicans on the House Appropriations Committee reiterated weeks of arguments that the state shouldn’t count on future federal money to expand health coverage. Also, they blasted the quality of care in Medicaid, saying, in part, it is often hard to find doctors to treat Medicaid beneficiaries.
“I’ll go door to door, I’ll go on any media, in any newspaper in my district, and I will tell every single person in my district I will fight with my last breath to keep you off Medicaid and get you on private insurance,” said Rep. Richard Corcoran, a Land O’ Lakes Republican who is a key architect of the House alternative.
But Democrats criticized the Republicans’ stance as ideologically driven and said the state should accept an estimated $50 billion in federal money that would be available during the next decade for Medicaid expansion.
They also pointed to a recent report from the state Agency for Health Care Administration that showed Medicaid expansion could help save the state $430 million a year in what is known as the Medically Needy program. That is because the federal government would pick up the costs for the program, which serves people who have costly conditions such as being transplant recipients.
“As a business person, you take a look at this and you say, how can you vote against it?” said Rep. Joe Gibbons.
Rep. Travis Cummings, an Orange Park Republican who is another architect of the House plan, said it could go to the House floor next week. If the House passes the bill (HB 7169) and the Senate approves a different plan, the issue ultimately could be decided by House Speaker Will Weatherford, R-Wesley Chapel, and Senate President Don Gaetz.
The House plan, dubbed the “Florida Health Choices Plus” program, would offer subsidies to two groups of people whose household incomes are at or below 100 percent of the federal poverty level. The biggest group would be parents of children, while subsidies would also be available to disabled people who qualify for the federal Supplemental Security Income program.
In all, about 115,000 people are expected to be eligible. As an example of the levels of income involved, a family of three could have an income of $19,530 and be at 100 percent of the federal poverty level.
Supporters of expanding Medicaid say it could provide coverage to roughly 1 million Floridians, as it would be available to people whose household incomes are up to 138 percent of the federal poverty level — or $26,951 for a family of three. While the House plan would not provide subsidies to people above 100 percent of the poverty level, Corcoran said those people could get coverage through a separate, federally subsidized health-insurance exchange.
If the state moved forward with the House plan, however, hundreds of thousands of childless adults below 100 percent of the poverty level likely would remain without coverage. A Medicaid expansion or the Senate plan to offer private health insurance would make coverage available to those adults.
Another key difference could be the types of coverage available to people in the House’s Florida Health Choices Plus program. A basic premise is that enrollees would be able to choose among options, with a requirement that they have preventive care and catastrophic care.
In part, that could involve using the subsidies to buy high-deductible catastrophic insurance policies. But with many health-insurance policies costing far more than $2,000 a year, critics question what type of coverage low-income people could find.
Also, the plan would require enrollees to add to the state subsidies by paying $25 a month. Karen Woodall, executive director of the left-leaning Florida Center for Fiscal and Economic Policy, told House members Friday that many people below 100 percent of the poverty level cannot afford to pay that amount.
“If the goal is to extend coverage to people in the state of Florida, I submit to you that you’re not going to be able to reach people with this plan,” Woodall said.
But Republicans said they are trying to take a free market approach, rather than expanding a Medicaid system that at least two lawmakers described as “failing.”
Rep. Dennis Baxley, R-Ocala, said states should become “incubators of better ideas than this massive dependency model” and recounted that he had foster children who were required to get coverage through Medicaid. He said doctors didn’t want to provide services.
“Folks, I hated it. …I wouldn’t condemn anybody to have to be on Medicaid that could possibly find a way to be on private insurance,” Baxley said.