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Is Gov. Rick Scott right to reject Florida's participation in expanded Medicaid under the Affordable Care Act?
Rich Bard's picture
Rich Bard
Opponents of Florida’s participation in an expanded Medicaid program under the Affordable Care Act echo the Republican governor’s argument that the state can’t afford it and that education and other priorities would suffer. Supporters of expanded Medicaid contend that extending coverage to more than a million uninsured, low-income Floridians will help the economy, strengthen families, and curb the rise in insurance premiums due to the cost of caring for the uninsured. Still others are waiting for the outcome of November’s elections before addressing the issue.
Laura Goodhue
Executive director of Florida CHAIN, a health advocacy organization
The highest court in the land has upheld the constitutionality of the Affordable Care Act (ACA), giving Florida an unprecedented opportunity to extend health coverage to more than one million uninsured, low-income Floridians through the expansion of Medicaid.
In particular, the ACA extends coverage to working poor adults who provide the backbone for Florida’s service-based economy. Although the court ruled that refusal to extend Medicaid coverage couldn’t cost the state its current Medicaid funding, Medicaid expansion is still the law. If state leaders refuse to expand Medicaid, they would have to answer to the Floridians who would be denied care as well as to the taxpayers whose dollars would be sent to other states even as their insurance premiums rise from shouldering the cost of caring for the uninsured.
Today, only the poorest of Florida’s children and their parents, vulnerable seniors and persons with disabilities have Medicaid.  By extending Medicaid to most Floridians up to 138 percent of the federal poverty level, a family of three with an annual income of up to $26,300 would qualify for coverage in 2014.  Many Florida service-sector workers, including hairdressers, cleaning attendants, cashiers, childcare providers, and others unable to purchase coverage on their own would qualify for the first time.  Extending Medicaid to these workers would strengthen Florida’s economy and Florida’s families.
The Medicaid program is already an effective safety net for millions of Floridians because costs are much lower than in the private market. Expansion is even more cost-effective for Florida, because the federal government pays the full cost for the newly eligible for three years. The most Florida will EVER contribute is 10 percent, and that’s only in 2020 and beyond.  In fact, if Florida rejects the additional federal Medicaid dollars, we will have lost $20 billion in federal tax dollars to other states that do extend coverage in the first decade alone.
Yet in arguing against Medicaid expansion, state officials, including the governor, have disingenuously inflated the costs of expanding.   The fact is Florida will spend less than 2 percent of its total Medicaid budget on extended coverage in one decade.  Each additional state dollar invested will draw down on average $9.51 in federal spending.  Opponents of the ACA claim that the additional $200 million a year in state spending requires a choice between funding healthcare or education, safety and infrastructure. However, consider that these same opponents provided $115 million in tax breaks to corporations last year alone.
Thanks to the ACA, countless uninsured Floridians would get secure access to care even if they lose a job, get sick or suffer injuries in an accident. Extending Medicaid coverage to Florida’s working families and boosting our economy is the only responsible policy option.  
For more information about Florida CHAIN, go to www.floridachain.org
J. Robert McClure, Ph.D.
President and CEO of The James Madison Institute, a nonpartisan policy center based in Tallahassee
In many a medical office, a worried patient – surprised by an unwelcome diagnosis – has turned to the doctor and plaintively asked, “What now?” The same question undoubtedly occurred to millions of Americans after the U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act (ACA).
Fortunately, Gov. Rick Scott has given Floridians a partial answer to “What now?” He affirmed that Florida won’t take part in two ACA programs – one that the court made optional and one that the law made optional.
First, Florida wisely won’t take part in the massive expansion of Medicaid. The ACA had threatened to reduce or cut off federal funding for current Medicaid programs in states that don’t participate.
However, by an impressive 7-2 margin, the court disagreed, ruling this punitive provision violated the states’ rights. This ruling vindicated the argument that The James Madison Institute made when it filed its amicus brief in this case.
Although critics of non-participation complain that Florida is spurning billions of dollars the feds will provide during the early years of Medicaid’s expansion, steering clear is nonetheless fiscally prudent in the long run.
Indeed, the current Medicaid program – the nearest thing to a blank check in the state budget -- is already devouring an inordinate share of it, robbing other important priorities ranging from education to public safety. So a costly expansion is the last thing Florida needs.
Governor Scott also says Florida won’t set up the kind of “health exchange” the ACA contemplates. In states that don’t set up such an exchange – essentially a “menu” of health-insurance plans -- the feds will do it.
So why should Florida bear the expense of doing this if there’s a chance that the ACA will be repealed, thereby letting states handle their own diverse needs without one-size-fits-all mandates from Washington, D.C.?
Granted, repeal is a long shot because there are no guarantees for the outcome of this year’s elections. But with Election Day barely 100 days away, it’s worth waiting until Americans on both sides of this issue can decide the fate of the ACA in the venue where these kinds of decisions are best made: not in the courts but in the voting booth.
For more information about The James Madison Institute, go to www.jamesmadison.org
Rich Bard's picture
Rich Bard
Associate Editor
Some other views about expanded Medicaid:
Soon after Florida Gov. Rick Scott indicated he would reject Florida’s participation in the expanded Medicaid program under the Affordable Care Act, Florida House Speaker-designate Will Weatherford, R-Wesley Chapel, issued this statement:
“We will not rush to judgment or predispose any action, not only because the complex decision must be reviewed, but also because we believe there is a solid likelihood that we'll be dealing with a new President after this election.  At the end of the day, we are going to take a rational approach that reflects the interests of Floridians, protects their hard-earned tax dollars and uses common sense.”
In a July 24 column on U.S. News & World Report’s “Debate Club” blog, Gov. Scott reiterated his opposition to expanded Medicaid because of costs:
“In Florida, Medicaid is the fastest-growing part of our state budget – hands down. It is increasing at more than 3.5 times the rate of our general revenue. And that’s before we even begin talking about an expansion. It doesn’t take a mathematician to figure out that such a trajectory doesn't bode well for our budget. And unlike the federal government, which isn't required to balance its budget, expanding Medicaid could only be paid for by increasing taxes or cutting from other parts of the state budget.”
State Rep. Scott Randolph, D-Orlando, also writing for U.S. News’ blog, argued that expanded Medicaid will lower costs for everyone:
“The middle class picks up the cost of providing care to the uninsured through taxes given to hospitals for uncompensated care and higher insurance costs. … By expanding Medicaid eligibility … very low-income people can move into the workforce without fear of losing coverage for their children. Simultaneously, the hidden tax of uninsured care and higher private insurance costs will decline as the population receives more preventive and primary care in place of ultra-costly emergency room treatments.”

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It is regrettable that those on the far right are satisfied with 50 million Americans going without health insurance. It is equally regrettable that the same faction is OK with those without insurance going to the ER for health care that is excessively expensive because the condition for which they are going could have been prevented or treated early had they had health insurance. The deplorable fact is that, since nothing is free, those of us with health insurance end up paying for those who don't. The GOP's position that the Affordable Care Act should be repealed belies the fact that they have not proposed an alternative. In fact, they have not made a serious attempt to reform the health care/insurance system in decades, if ever. It is shameful that the U.S. health care system is ranked 37th by the World Health Organization. In 2010, we spent 17.9% of the gross domestic product on health care, much more than any other country. Yet, we received far poorer results than many nations. According to the CIA World Factbook, U.S. death rate ranks 144th, life expectancy at birth ranks 50th, maternal mortality rate ranks 52nd, and infant mortality rate ranks 49th. Yet, one side of the Congressional aisle seems absolutely content with this situation, obsessed with repealing the ACA and maintaining the status quo. Our governor seems overjoyed with it. For low income folks in Florida, forget the penicillin, let them eat cake.

by Dr. Radut.