Care to stay? The prognosis for Medicaid expansion and Obamacare’s future.

click to enlarge “I think there are private sector health care coverage options for many people,” says U.S. Rep. David Jolly. - Kevin Tighe
Kevin Tighe
“I think there are private sector health care coverage options for many people,” says U.S. Rep. David Jolly.

Florida lawmakers’ past refusal to accept $51 billion to expand Medicaid under the Affordable Care Act — or, you know, Obamacare — means roughly 1 million people pay dearly for things like disease screenings and medications, or just go without.

If Florida had accepted the money as nearly 30 other states did, an estimated 800,000 people who are under 138 percent of the poverty line would be eligible for full coverage. Instead, they can’t get covered by the present Medicaid system because, even though they’re poor, they’re not poor poor. They’re working-three-restaurant-jobs-to pay-off-student-loans poor, not can’t-afford-bus-fare-to-the-doctor poor.

At least 670,000 Floridians have already enrolled in Obamacare through the federal healthcare exchange — more enrollees than in any other state. But even though most of those policies are subsidized, they’re still not affordable for some. Money to cover the slightly less poor is on the table, and all state lawmakers would have to do to cover them is say yes.

But if the past is any indicator, those uninsured Floridians are S.O.L. In 2013, a measure to accept federal funding for Medicaid expansion passsed overwhelmingly in the State Senate, but the state House didn’t touch it.
Still, health care advocates are an optimistic bunch.

“We are seeing more and more policymakers, business leaders, hospitals faith leaders and others stepping up and calling on lawmakers to close the coverage gap,” said Athena Ford, advocacy director with the pro-ACA nonprofit Florida CHAIN.

House Minority Leader Mark Pafford, a Palm Beach Democrat, mirrored that rosy outlook in a recent Ocala Star-Banner op-ed. “It is not only our caucus that continues to beat this drum,” he writes. “A coalition of business groups has proposed an expansion of coverage that would make health care accessible to more than 800,000 Floridians now left out.”

He’s referring to “A Healthy Florida Works,” a program endorsed by 700 businesses and organizations that would also require participants to pay “nominal” premiums and take part in job-training programs.

But incoming Florida House Speaker Steve Crisafulli (R-Merritt Island) is skeptical about the proposal’s “many unanswered questions.”

“If this is just another attempt to expand the failed Obamacare plan,” he said in an emailed statement, “I would predict it would garner very few votes in the Florida House of Representatives.”

His skepticism echoes that of fearmongering GOP House candidates who warned that Florida would be on the hook for the Medicaid expansion if federal funding were to dwindle.

In fact, the $51 billion would cover the expansion through 2016, after which the state would pay for 10 percent of costs associated with the program. According to Health Care for Florida Now, that adds up to $2.1 billion over a decade, or just 2 percent more than what the state’s already paying for Medicaid. Proponents also argue lawmakers could shield the state from being on the hook even if the feds were to pull out.

The ACA continues to face existential threats from congressional Republicans, who have tried to repeal the law dozens of times, and possibly from the U.S. Supreme Court. A case coming up before the Court this year proposes to do away with the federal exchange altogether because of perceived ambiguity in ACA language. U.S. Rep. David Jolly (R-Indian Shores) filed a bill dubbed the “Patient Freedom Act,” which would repeal the law’s individual mandate component.

“I think the American people are smart enough to make health care coverage decisions for themselves,” Jolly said in an interview. “This simply says, if you like Obamacare… then you can keep it.”

Of course, removing the requirement that nearly every American have insurance would, as Jolly puts it, make Obama “justify the price control economics behind Obamacare,” or, put another way, implode it. If the ACA goes away, that would leave millions of people uninsured. Jolly said while he wants Republicans to offer a government-based solution for people with preexisting conditions, he sees no problem with going back to how things used to be.

“I think there are private sector health care coverage options for many people,” he said.

Ford of Florida CHAIN said she’s not worried about what Congress does at the moment, given President Obama’s veto pen. And even if an anti-ACA president is elected in 2016, there’s a chance the law could stay put. As more people come to rely on their plans, the less likely they are to tolerate politicians who want to take it away.

“Health care reform is becoming more and more popular every day,” she said. “Any attempt to repeal or chip away at the new health care law is really going to anger a lot of constituents.” 

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