Amid a deteriorating budget stalemate that is splitting Republican legislators, U.S. Sen. Bill Nelson stepped into the fray with a message that the loss of more than $2 billion in Medicaid dollars for hospitals is a real threat.
“The day of reckoning is here,” said Nelson, who made a quick visit to the state Capitol Wednesday.
Nelson’s blunt message–which he delivered to both House Speaker Steve Crisafulli and Senate President Andy Gardiner–wasn’t reflected by House Republicans in their debate about the budget. Both the Senate and House spent most of Wednesday discussing rival spending plans that, because of a split over how to handle health care, are more than $4 billion apart.
The budget chasm exists because the Senate has crafted a replacement program for hospitals with the assumption that the current program known as the “low income pool” won’t be extended. The Senate is also pushing to expand healthcare coverage to 800,000 Floridians by drawing down federal aid linked to President Barack Obama’s healthcare overhaul.
State Rep. Matt Hudson, the Naples Republican in charge of the House budget committee, said he had “faith” that the federal government would approve some sort of replacement program for the state’s low-income pool. The current program is due to expire this summer.
Hudson said that if the federal funding isn’t replaced, then the blame will be on the federal government for cuts that may have to be absorbed by local hospitals. Hudson also said that the state will get the replacement money without having to draw down money from Obamacare.
Nelson, however, said that House and Senate leaders shouldn’t be playing games when it comes to deciding healthcare funding that helps treat the state’s poor and uninsured. Nelson, again contradicting House Republicans, said the fate of the low income pool program for hospitals is intertwined with the expansion of Medicaid.
“We shouldn’t be playing a game of chicken when we are talking about the health care for over 1 million people in the state of Florida that do not have health care now,” Nelson told a group of reporters outside the Senate chamber after he met with Gardiner.
Prior to meeting with Gardiner, Nelson also met with House Speaker Steve Crisafulli in his office for about 15 minutes. Nelson said he was alone with Crisafulli and that House Appropriations Chairman Richard Corcoran was not in the meeting.
Under the federal healthcare law–people living at or below 138 percent of the federal poverty level, or $33,000 for a family of four in Florida–would qualify for Medicaid. More than $50 billion in Medicaid dollars are available to Florida if the state chooses to expand Medicaid and cover those who would qualify.
The Republican-led Legislature, though, has been loathe to implement any of the provisions in Obamacare, from establishing a state health exchange to expanding Medicaid for working poor to purchase Obamacare plans to expanding Medicaid.
While there is some resistance in the Senate to expand Medicaid, the real opposition has come from the Florida House of Representatives. The House shot down a Medicaid expansion in 2013 under former House Speaker Will Weatherford and the issue wasn’t broached in the 2014 session.
It has resurfaced in 2015, though, because the Centers for Medicare and Medicaid Services won’t extend LIP for another year.
LIP funds are a combination of mostly local and federal dollars with a smattering of state funds. LIP dollars in Florida are used mostly for hospitals, but also federally qualified health centers, graduate medical education and HMOs.
When the Centers for Medicare and Medicaid Services agreed to let Florida implement a statewide Medicaid managed-care program, it told the state that LIP would be in effect only through June 30, 2015.
“The day of reckoning is here,” Nelson said of the expiration date. “And these two chambers are going to have to work it out.”
