A Senate panel Monday defied Republican Gov. Rick Scott’s call for expanding Medicaid, with GOP leaders saying they are now intent on crafting their own plan to provide health coverage to 1 million low-income residents.
Senators from Scott’s own party ridiculed expansion as building on a broken Medicaid program, which committee Chairman Joe Negron, R-Stuart, called a government-driven, inflexible model reminiscent of the 1950’s Soviet Union.
“My goal is we get out of the federal Medicaid system as we know it,” Negron said. “Now, we can’t do that all at once. But we have an opportunity to begin that process.”
Negron said lawmakers should use the two-decade-old, Florida Healthy Kids program as a framework for expanding coverage, “rejecting the Washington plan but creating a Florida plan.”
He offered few details. But Negron said he expected Senate committees to spend coming weeks crafting a plan that he thought could win quick approval from the Obama administration and still be financed by billions of federal dollars.
But the action also cast Scott adrift, politically. The Republican governor angered conservatives last month by endorsing expansion for at least the three years it will be fully financed by the federal government.
Scott, a longtime opponent of the Affordable Care Act, called expansion “common sense.” But last week, a House committee rejected Scott’s proposal, a stance affirmed by House Speaker Will Weatherford, R-Wesley Chapel, on the session’s opening day.
The Senate’s action Monday appears to kill any prospects of a traditional expansion emerging from this spring’s Legislature. But Scott found a silver lining.
“”I am confident that the Legislature will do the right thing and find a way to protect taxpayers and the uninsured in our state while the new health care law provides 100 percent federal funding,” Scott said after the 7-4 vote by the Senate committee, in which the only support for Medicaid expansion came from Democrats.
While Democrats seemed blindsided, they also pointed out that Republican leaders were defying major business associations and the Florida Hospital Association, traditional allies of the GOP, which have embraced the expansion.
“We have a moral and economic responsibility to seize this moment for the good of Floridians,” said Sen. Eleanor Sobel, D-Hollywood.”
Scott last month became the seventh and highest profile Republican governor to agree to Medicaid expansion.
But Republican legislative leaders clearly remain unconvinced. They also have become intrigued by new proposals in Arkansas and Indiana that put a twist on Medicaid expansion.
Led by Democratic Gov. Mike Beebe, Arkansas is considering a plan that would allow those who qualify for Medicaid to obtain private insurance coverage through the online marketplaces called health exchanges, which are a key part of the federal health care changes which mostly begin taking effect next year.
Indiana Gov. Mike Pence, a Republican, is spearheading a drive to enroll as many as 400,000 low-income residents in state health savings accounts, with the federal government picking up the costs. Pence is asking the federal Centers for Medicare and Medicaid Services to approve the action.
In laying out a sketchy outline of his own idea, Negron on Monday said Florida’s Healthy Kids program could be expanded to include another 1 million adults and families.
Healthy Kids, created under late-Democratic Gov. Lawton Chiles, currently serves 250,000 children, aged 5-18, whose parents pay $15-20 monthly for health coverage. They can choose from at least a couple of private health plans available in each of Florida’s 67 counties.
Republicans on the Senate Affordable Care Act committee Monday said repeatedly that it was important for people in the Medicaid to pay some kind of fee, to discourage abuse in the system.
The Centers for Medicare and Medicaid Services earlier rejected the state’s proposal to charge fees for emergency room services under a Florida Medicaid overhaul approved earlier this year, which converts traditional fee-for-service Medicaid coverage to managed care.
Negron, though, said charging fees for the Medicaid population covered under expansion is authorized by the federal government.
Expansion would increase program eligibility to 138 percent of poverty, which means a family of three could qualify with an income of about $26,300. The current cutoff is about $9,600. For the first time, adults without a disability or children can qualify with an income about about $15,000.
“Why should you should be on Medicaid, you have to get in a line, have a big ‘M’ stamped on your forehead, you have low reimbursement rates, doctors don’t want to see you,” Negron said. “Why would we not want to empower people to say, you’re not ‘on’ anything. You have something. You own something. You will be treated as you should be, like a citizen.”
Florida could draw $51 billion from the federal government over the next 10 years with the Medicaid expansion, an amount recently revised upward by state economists.
While the first three years would be fully covered by federal officials, state taxpayers would pay $3.5 billion to get the dollars through the subsequent seven years.
“I do not see the solution as doing nothing,” said Sen. David Simmons, R-Altamonte Springs. “But I do not see the solution being Medicaid expansion in its traditional form.”