The Affordable Care Act. (Fine, Obamacare.)
The controversial health care reform effort was a major talking point heading into the 2010 midterms and the 2012 presidential election, and to this day some Republicans still like to cast their Democratic (or moderate Republican primary) opponents as Obama-lovin', socialized medicine-peddlin' commie-nazis bent on quadrupling the national debt out of pure hate for America. Or something.
In Florida, though, Democrats and progressives hope to turn that argument upside-down, and in St. Pete Wednesday they touted a different narrative: Florida's Republican-dominated Legislature and Obama-hatin' Governor Rick Scott are costing us all money — and themselves any moral high ground they think they think they have — by rejecting billions in federal Medicaid dollars currently on the table. That money could provide health care to nearly a million Floridians who currently make too much money to qualify for Medicaid and not enough to have their insurance subsidized by the federal government.
"It's been six years since the Afforable Care Act, or what's known as Obamacare, was signed into law. Six years. And unfortunately, Florida and the Tampa Bay region continue to lag behind in the nation and help outcomes and access to healthcare," said St. Petersburg Mayor Rick Kriseman on the steps of City Hall Wednesday morning.
He cited a study by the Robert Wood Johnson Foundation and the Pinellas Health Department showing Pinellas County as ranked 33rd in health outcomes, quality of life and length of life, largely due to preventable chronic diseases like cancer and heart disease.
Detecting those conditions early — or encouraging lifestyles that don't bring on such conditions — makes sense financially as well, he said.
"Expanding coverage isn't just about doing the right thing. It isn't just about doing the healthy thing. It makes good fiscal sense as well," Kriseman said. "The cost to Tampa Bay area hospitals for providing care to uninsured patients... is more than $370 million. Expanding coverage would greatly reduce this cost."
Plus, it leads to jobs; Kentucky added 23,000 related jobs after it expanded Medicaid.
Troy Quast, a professor of health policy at University of South Florida, said providing health care can be a tool for economic growth in other ways.
"The improved financial stability will also help low-income individuals avoid financial death spirals from high in-sum healthcare costs," he said. "Businesses will also likely benefit from increased productivity of workers due to their improved health."
He noted that the picture wasn't all rosy for states that accepted the Medicaid money. Namely, some states didn't see any immediate change in the number of emergency room visits, and some state provider networks had trouble keeping up with the influx of new patients.
"However, I believe the long-term prognosis for expansions is quite positive," Quast said. "It seems likely the ER usage will be on the decrease as enrollees become more accustomed to visiting their primary care providers rather than going to the ER."
Plus, there's the fact that Low Income Pool (LIP) dollars are diminishing, said State House Minority Leaded Mark Pafford, CEO of Florida Clommunity Health Action Information Network (CHAIN). The federal hospital emergency room reimbursement program is being phased out, the thought being that it'd become obsolete as Obamacare came online.
But with the U.S. Supreme Court decision leaving it up to the states to accept federal Medicaid money or not, once LIP goes away, that doesn't mean demand for ER care will fade as well. In fact, it probably would go up or stay the same — and someone's got to pay for it.
"This is hitting taxpayers and to suggest it's not having an impact on the economy, I think, would be foolish," Pafford said.
James T. Golden, social action coordinator with the 11th Episcopal District of the African Methodist Episcopal Church, which covers the State of Florida and the Bahamas, said the fiscal sense is an obvious incentive, but the moral argument — that a society take care of its people — should compel lawmakers of every political stripe to act.
"It is not right to look at Medicaid expansion as a cure. It is the prevention that stops us from years down the road being faced with our inaction and our inability to help people that we meet and that we represent on a daily basis," he said. "We need to have a stronger network. We need to have more opportunities for people to not have to go to the emergency room at 12 at night when they could have gone to see a doctor at noon."
But will lawmakers take up the issue in Florida during the next legislative session?
Morbidly obese chance.
The incoming State House Speaker, Richard Corcoran, has already said he's not interested, and they're still letting Scott's thin, scaly fingers wield a veto pen.
Then there's the specter of a Donald Trump presidential win, which, should the U.S. House and Senate keep their Republican majorities, would be an existential threat to the Affordable Care Act.
Pafford said he's ever-optimistic that it'll happen; the Senate has picked it up in the past and the legislature spent weeks quarreling over it, until the House decided to pick up its marbles and go home.
Plus, Kriseman said, for Gov. Scott to seek federal funding to help combat the zika virus, while rejecting expanded Medicaid is the "epitome of hypocrisy" that could come back to haunt him and other Republicans at the polls.
"We are in the middle of the election," he said. "And every registered voted, and in particular those who would have coverage if expansion occurred but don't now, ought to be asking the question of every single member of the House and Senate who is up for reelection: where are you on this issue? What is your position on this issue? And if it doesn't align with expanding coverage, then you're not going to get my vote. And that's why it's important right now."