Florida's Medicaid Expansion Decision: A Clash of Politics, People and Perceptions

Some offers are easy to reject using just common sense. I had assumed that the decision regarding taking billions of federal funds for Medicaid Expansion was in that same category, but for many legislators, the choice is not so straight-forward.
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Some offers are easy to reject using just common sense, like trying to decide whether or not to buy a pregnancy test at a Dollar Store. I had assumed that the decision regarding taking billions of federal funds for Medicaid Expansion was in that same category, but for many legislators, the choice is not so straight-forward.

For many on the consumer side, it seems just that simple. If you are low income and you cannot afford to buy private insurance, or you are a small business, aware of the upcoming mandate, and you employ more than 50 full-time, low-wage employees, the Medicaid Expansion will open the safety net for you or your employees. Then you can go to the doctor to maintain your health or the health of your employees and be happier, healthier and more productive.

To the bean-counters and finance majors, it seems like a pretty solid deal, too. For the first three years, the Feds will pay for 100 percent of the cost of the Medicaid Expansion, and slowly creep down to 90 percent in year ten. That means that for every dollar the state puts out for this program, the federal government will leverage it with $9.51. That will come in handy, because the Patient Protection and Affordable Care Act (PPACA), or Obamacare, also has a hefty administrative costs that the states will bear, and the matching funds, which could equal as much as $55 billion over the next ten years can cover those costs, as well as help to create as much as 120,000 jobs for the state.

However, for the politicians and elected officials, the choice doesn't appear to be so clear-cut. Those on the Democratic side seem to be overwhelmingly for it, those on the Republican side... not so much. Those on the left see the consumer side, with millions of healthy lives at stake. Those on the right talk of Medicaid, with its 48-year record of helping low-income families, children and the disabled, as "broken." They see the quagmire of the U.S. Congress, and a rapidly and ever-growing deficit, in part stemming from paying for a war that was waged "off the ledger books" and on credit, that many never wanted. Many Republicans worry that the feds will renege, leaving Florida (a state that has had funding shortfalls for many years, in part from paying out 30 percent of its budget to cover the state share of Medicaid) holding the bag. As Rep. Matt Hudson(R-Naples) told me, "Even backing off by a single percentage point could be devastating."

With this kind of divide, many have wondered if health care is a bipartisan issue. Nothing could be farther from the truth.

It has been said that the differences between hope and optimism and fear and pessimism are the same. Hope and fear are based on emotion, optimism and pessimism on knowledge of the facts. While observing members of both parties, I have seen both.

I have seen Republicans who say that hate Obamacare, but when asked which of several aspects of the PPACA they dislike, they tend to like most of them. I have seen those on the Democratic side that are so blinded by the humongous law that was so long in coming that they don't mind turning their heads away from the fact that it is a huge gift to for-profit private insurance companies, with an high rate of administrative costs.

There are mitigating factors and dispelling facts to both viewpoints. The right looks at the problems in Washington, with their stalemates, stagnation and sequester. They see a budget that has not been passed in five years, (even though the state must, by mandate, pass a balanced budget each and every year) and an ever-rising deficit, and wonder if the feds will be forced to back down on their side of the deal. They neglect to notice that, since the initial implementation of Medicaid, despite budget problems that have occurred during the time it has been in force, the feds have never failed to meet the state matching funds. Many on the Democratic side put away the idea of single-payer option, which could have reduced administrative costs. The average private insurance plan uses between 80-85 percent of premiums for patient care, based on various reports. the Council for Affordable Insurance, a private insurance supportive agency lists the number at 83 percent. Medicaid comes in at 93 percent. Less private insurers and more single payer options would have mitigated the high administrative cost of the PPACA.

So is healthcare a bipartisan issue, with each side vying to weigh the grand compromise heavier on their side?

NO. Healthcare policy making may be partisan, but health and healthcare is not. Health is a non-partisan commodity. No politician, no bean-counter, no consumer would ever feel that health is a quality that only those whose allegiance to one particular side of the aisle should be able to obtain. It is the path to get there that is in dispute.

Even in the normally divided Florida legislature and the leaders of the state's administrative branch, you can see proof of the non-partisan nature of healthcare. Governor Rick Scott, who led the charge against Obamacare, changed his view and stated that it would be unconscionable to refuse healthcare to the 1.2 million Floridians who would benefit. The Republican-heavy Florida senate stated that just saying "no" was not an option, and looked for a program that allow them to say "yes" using federal funds and a Medicaid-style plan that utilized private insurance. Even the House, whose committee headed by Rep. Richard Corcoran (R-Land O Lakes) said "no" after months of passionate and fact-driven testimony, said that they are looking for a way to increase access to health care.

So the only thing that is getting in the way is the politics of creating health policy. Some in the legislature say the big problem is in the politics of using Medicaid, a federal program that attached itself to states by mandate 48 years ago with a 53 percent-47 percent match from the feds. As reported by the Miami Herald, Sen. Negron hasstated, "Medicaid has commandeered the state budget and crowds out our ability to fund other worthwhile priorities, such as our colleges and universities, public safety and transportation," The other 800-pound political gorilla is the aversion to accepting a much larger amount of federal funds. These concerns are getting in the way of moving forward to improve healthcare access to those who need it most.

No one alternative program offered so far is perfect. The Negron Plan (or Florida Plan) uses the federal funds that many in the House and some Senate Republicans despise, and neglects to address important lifelines to the most vulnerable citizens -- those with severe physical and developmental disabilities, including medical waivers. Karen Clay, an advocate for the Developmentally Disabled and caregiver to a truly amazing but physically challenged son expressed her concerns to me. "The Medicaid waivers for the developmentally disabled afford the opportunity to choose who will provide your care and provide the supports and services such as attendant care, personal care assistance, respite, etc. The concern regarding any other 'alternate plan' is the loss of choice, continuity of care and familiarity." Without a plan in place, he disabled stand a greater chance of being institutionalized, which often reduces health outcomes and quality of life.

The Bean Plan, also called Healthy Choice Plus, offered by Sen. Aaron Bean (R-Jacksonville) only addresses those under 100 percent of the Federal Poverty Line (FPL). Bean, who has stated that we need to beware of becoming "addicted to federal funds," has created a plan that among other things has those individuals and families between 100 percent and 138 percent of FPL going strictly to the insurance marketplace (exchange), and relying on federal stipends to cover premiums. (Maybe he feels they will be less likely to become addicted.)

The main points of the bottom line of this issue are that:
  1. all those parties involved truly believe that health and healthcare is a non-partisan issue,
  2. the Federal Money earmarked to cover Medicaid expansion has, in essence, already been spent on all of the states,
  3. if Florida doesn't take it, the money will just go to another state, and
  4. the tax-paying citizens of Florida, the great "donor state," will be paying for some other state's Medicaid Expansion program.

Floridians shouldn't bother waiting by the mailbox for the thank you note from Arizona or any other state that will be spending the money originally intended for Florida.

To all of those putting politics before the truly non-partisan issue of access to health care, including the members and speaker of the House, and the Senate president and senators -- Take the money! It belongs to the Great State of Florida, and it's for a good, non-partisan cause.

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