Medicaid expansion in doubt, but are there other options?

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With House Speaker Will Weatherford emphasizing that he doesn’t want to expand the Medicaid program under the federal Affordable Care Act, Senate President Don Gaetz on Tuesday said it appeared the House “has shut the lights off” on the issue, reports Jim Saunders of the News Service of Florida

“When the House of Representatives says no — if they do — that pretty much shuts down the discussion,” Gaetz said.

But House and Senate Republicans seem to be leaving open the possibility of coming up with a plan to provide health coverage to more low-income people. One idea floating around stems from a federal-government move last week that would allow Arkansas to funnel people into private insurance coverage instead of Medicaid.

Gaetz, R-Niceville, said the Senate is looking into the Arkansas idea, as well as other potential health-care models. The Arkansas concept centers on allowing low-income people to use federal Medicaid money to buy private coverage through a new health-insurance exchange.

The Affordable Care Act, better known as Obamacare, calls for raising the income threshold to qualify for Medicaid and allowing the enrollment of childless adults, a group that is largely barred from the program now in Florida.

But the Republican majority on a House select committee voted Monday to oppose the expansion, and Weatherford backed that stance Tuesday during comments to open the annual legislative session.

“I believe it forces Florida to expand a broken system that we have been battling Washington to fix, and I believe it will ultimately drive up the cost of health care,” said Weatherford, R-Wesley Chapel. “This inflexible plan, thrust upon us by the federal government, is not aimed at strengthening the safety net. It pushes a social ideology at the expense of our future.”

Despite that opposition, House select committee Chairman Richard Corcoran, R-Land O’ Lakes, has said repeatedly this week that he wants to look for ways to expand health coverage and provide a safety net. He said the Arkansas idea arises out of the notion that people would rather have private insurance than get coverage through Medicaid, but he also said such private coverage likely would have higher costs.

A Senate select committee postponed a scheduled discussion of the Medicaid expansion Monday, and Gaetz said it does not have a timeline for making a recommendation. The committee is scheduled to meet again next Monday.

But the overall divisions about the Medicaid issue were on display during Tuesday’s opening of the annual 60-day session.

Shortly after Weatherford blasted the expansion, Republican Gov. Rick Scott touched on his support of the proposal during his State of the State address. The federal government would pay 100 percent of the costs of the expansion during its first three years, with the state gradually picking up part of the tab after that.

“I concluded that for the three years the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care,” said Scott, whose comments drew an ovation from Democrats who back the expansion.

Florida lawmakers during the past 15 years have made a few attempts to expand health-insurance coverage but have had little success. State economist Amy Baker on Monday presented a report to lawmakers that indicated about 4 million Floridians — more than 1 in 5 — lack health insurance.

The Associated Press reported this weekend that Republican lawmakers in Arkansas still had numerous questions about moving forward with the private-insurance concept instead of a Medicaid expansion and that the issue still faces hurdles in that state.

But in at least one major way, it appears that the Arkansas idea could appeal to Florida’s GOP-dominated Legislature, which has long railed about the costs and size of the Medicaid program. Politically, it might be easier to have low-income people buy coverage from private insurers rather than enrolling them in Medicaid.

Florida already is moving toward a statewide system of enrolling Medicaid beneficiaries in HMOs and other types of managed-care plans. But the Arkansas concept would be different, because people would buy their coverage through insurance exchanges, which are online insurance marketplaces being set up through the Affordable Care Act.

The federal government already plans to run an insurance exchange in Florida, with many people able to receive subsidies as they buy coverage through it. Florida declined to run the exchange, defaulting to the federal government.

Peter Schorsch is the President of Extensive Enterprises and is the publisher of some of Florida’s most influential new media websites, including,,, and Sunburn, the morning read of what’s hot in Florida politics. SaintPetersBlog has for three years running been ranked by the Washington Post as the best state-based blog in Florida. In addition to his publishing efforts, Peter is a political consultant to several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella.