It might be best described as a perfect storm for health care in Florida, and those who tried to fight against it are watching it approach in slow motion.
It’s no secret that Florida’s political leadership is again spurning $51 billion in federal dollars that would, under the Affordable Care Act/Obamacare, cover health insurance for around 600,000 people in the state.
It’s also no secret that the federal government is cutting by some 75 percent its disbursal of Low Income Pool (LIP) dollars to the state, money that covers uninsured people when they visit the emergency room or any other facility that offers “safety net” health services.
But even if county officials saw these things potentially on the horizon years ago, they are now scrambling to figure out how they’re going to fill the gaps.
“Essentially what the state is doing is pushing the obligation down to the county level and I think, I can’t speak for other counties, but certainly in our county, I don’t believe that we are prepared to really deal with the consequences of this and that we need to get into high gear,” said Miami-Dade County Dist. 8 Commissioner Daniella Levine-Cava, an attorney and social worker who has advocated Medicaid expansion in Florida for years. Miami-Dade has the highest number of uninsured in the state.
About 600,000 Floridians either make a little too much money to qualify for Medicaid under current rules, or not enough to qualify for an Obamacare subsidy.
Last year the state House and Governor Rick Scott ignored pleas from the state Senate, health care advocates and medical professionals to accept the Medicaid dollars to offset disappearing LIP money. Ostensibly, the rationale for rejecting the money was the possibility that the feds (or Congress under a Republican president) would torpedo Obamacare, leaving the state solely responsible for covering the uninsured. It’s unclear where that money is going to come from now.
“County officials are really going to have to figure out how to provide care to low-income, uninsured residents with decreased LIP funding and other sources of safety net funding that, in the past, have gone to the counties, and that the counties have relied on that will no longer be coming into the counties,” said Charlotte Cassel, Equal Justice Works Fellow with Florida Legal Services.
Critics accuse House leadership and the governor of playing politics, essentially trying to make Obamacare look bad by not letting the program roll out as the feds intended. Some are also concerned about what will happen to the health care industry and the economy as a whole if the state doesn’t accept the money.
“If we don’t take care of people, basically, they can’t participate in our community,” said Dena Gross-Leavengood, health care committee chair for the League of Women Voters of Hillsborough County. “They can’t help the economy. They can’t work if they’re not healthy, and if they’re not healthy they can’t take care of their children.”
Plus, she said, if hospitals aren’t reimbursed for caring for the poor and uninsured, they won’t be able to hire as many people.
“If you think you wait long in the emergency room now, you wait until they have to cut back on the emergency room staff,” Gross-Leavengood said.
Hillsborough County is unique in the state in that it has a half-cent sales tax that funds a health care program for low-income residents. But without the LIP money to bolster the county’s efforts, the program could erode.
“It’s a big deal. It’s a really big deal,” Gross-Leavengood said.
Levine-Cava hopes there’ll be a silver lining when the cuts come — that state officials will see what impact they have on the community and reverse course on Medicaid expansion. But given Scott’s attitude toward the hospitals that provide safety net care, she’s not optimistic. Scott is a former for-profit hospital chain exec who has accused hospitals that receive LIP money, many of which are nonprofits, of trying to protect their revenues.
“Truthfully, I did think that the hospitals’ pain would help move this agenda item, but… the governor has also taken aim at hospitals like Jackson [Health System], which is our largest system, and basically is telling them that they are collecting more revenue than they need,” she said. “And so he’s not really providing much sympathy for the struggles of the hospitals that meet the needs for uncompensated care.”
This article appears in Jan 14-20, 2016.