Six years after the passage of the Affordable Care Act, the debate over the law and how best to apply it continues in the state of Florida. Recently, a group of academics, religious leaders, and politicians supportive of the Act’s Medicaid expansion provisions gathered outside City Hall in Tampa Bay, FL to call on legislators to reverse their opposition to expanding Medicaid access for the state’s residents. As part of their new call for expansion, the group relied on a new report from a pro-expansion organization known as Florida CHAIN.
What is Medicaid Expansion?
When the Affordable Care Act was passed by Congress in 2010, it included provisions that encouraged states to expand their Medicaid coverage to residents whose income is below 138% of the poverty level as defined by the federal government. That poverty level is currently set at $16,394 for a single individual. For a family of four, the federal poverty level is $33,534. For states that agree to expand their coverage in this way, the federal program promised to pay for all of the expansion costs – at least at first. Over time, the federal share of the expansion costs would decline to 90% by 2020.
What’s Florida’s Position?
The Florida legislature has thus far resisted all calls to expand the Medicaid program in the state in the way that the ACA envisioned. Three years ago, the state Senate did propose a plan that would have used the money provided by the federal expansion program to help low-income Florida residents purchase insurance policies on the private market, but that idea was nixed by the House. Then, and now, opponents of expansion have asserted that the Medicaid program is not stable enough to expand in this way.
Last year, Democrats and Republicans in the legislature argued the issue once again. The debate has been fierce on both sides of the aisle, and no compromise on the matter is likely any time in the near future. The positions of those on both sides of the debate have only seemed to harden as time goes on.
Why it Matters
Some have suggested that the issue of Medicaid expansion seems to be a debate over precisely the wrong question. For decades, much of the health care debate has focused on stemming the rising cost of care. Somehow, that debate transformed into an argument over how best to provide insurance to patients – something that has little to do with driving down the cost of health care services. Instead of focusing on ways to reduce costs and increase patient access to those services, proponents of universal health care chose to emphasize universal health insurance – even if it meant that costs might continue to rise.
Now, however, the drive to expand Medicaid may be the best of a number of bad options. As government has subsidized more care than ever before, many Americans have seen their old private health insurance policies fall by the wayside. Others have seen their premium costs rise, even as millions receive free or subsidized care for the first time in their lives. As the old order has been gradually swept away and replaced by the new ACA-enforced patient care and health insurance dynamic, the economy of Florida and much of the nation has adjusted to this new dynamic.
Medicaid expansion under the terms of the ACA is now not just about providing more access to insurance for lower-income Floridians, but about ensuring that the state gets access to its fair share of the federal largesse that an expansion of benefits makes possible. That fact is demonstrated pretty clearly within the pages of the new report cited by these expansion advocates.
Benefits for Florida
The report cited a few key findings that proponents suggest should prompt lawmakers to adopt the expansion. In noting that other states have seen self-reported health improvements after expanding Medicaid access, the report suggests that Florida could realize similar benefits. It also asserts that the state’s Veterans’ Administration system could enjoy some measure of relief if many uninsured veterans were moved out of the VA system and onto the Medicaid rolls.
Perhaps the most interesting direct appeal to economic benefits comes in the form of the report’s claim that the infusion of federal money into the state would revitalize local economies. The claim included an assertion that 23,000 new job opportunities could be created in the Tampa Bay area alone. If true, that might induce at least some legislators to shift their position toward approval of any expansion measure.
Medicaid or Bust?
It is almost certain that proponents of expansion will continue to press for including more people in the Medicaid program until they either get control of the legislature and pass it themselves, or someone comes up with a better alternative. After all, those who support universal health care spent decades campaigning for some version of a single-payer system before finally settling for the Affordable Care Act’s compromise system. It’s difficult to imagine Florida not eventually succumbing to the relentless pressure and passing some version of an expansion.
At his point, the entire health insurance market has been skewed to the point where millions of people really won’t ever be able to gain access to affordable care without programs like Medicaid. That alone makes some form of expansion in our state an almost certainty. The only real question may be what form that expansion will eventually take and whether we will have waited too long to enact it.
Medicaid for Senior Needs
Of course, the debate over Medicaid planning is but one issue surrounding the program and its important role. Medicaid is also the largest payer for nursing home residents, and thus plays an important role in long-term care too. At Robert Kulas Attorneys at Law, our Medicaid planning experts can help you or your loved ones to develop sound strategies today to ensure that you can access the benefits you need tomorrow. Give us a call at (772) 398-0720 or contact us online to find out more about how we can help you with these and other important concerns.
