Florida’s Ron DeSantis is now officially a candidate for president, and so far his campaign is going about as expected.
The Republican governor has decried the “malignant ideology” of the left and “the woke mob,” and he’s promised to make the rest of America more like his “free state of Florida.” He has suggested that Disney is trying to brainwash America, and he’s gone after former President Donald Trump, albeit indirectly, by urging Republicans to “dispense with a culture of losing” during an appearance in New Hampshire.
These are the subjects DeSantis wants to discuss and, quite possibly, the ones that matter most to Republican primary voters. But there’s another topic in the news that could use some attention.
Over the past few weeks, roughly a quarter of a million Floridians have lost health insurance coverage through Medicaid. And that’s just the beginning. In the coming months, even more Medicaid beneficiaries in Florida could lose their coverage as well ― with many, and quite possibly most, ending up uninsured altogether.
It’s a big deal in Florida. It should be a big deal elsewhere too, because a major reason for the coverage losses is a series of policy decisions that DeSantis and his administration have made. These decisions say a lot about his priorities and values, and how he might govern as president.
The End Of A Pandemic Policy
The story unfolding in Florida is part of a larger one playing out across the country, as the federal government ends the last of its COVID-19 emergency measures. One of those initiatives focused on Medicaid, the health insurance program for low-income Americans that states administer using a combination of their own funding and money from Washington.
Some states make it relatively easy to enroll and stay on the program. Others don’t. And especially in the states that make it more difficult, tons of people lose their coverage even though they remain eligible ― in some cases, simply because they couldn’t figure out the paperwork. It’s a situation that advocates have long decried, and one that even Medicaid critics agreed was problematic in the pandemic, when the need to get medical care was so urgent.
That’s why the pandemic relief package that Congress passed and Trump signed in March 2020 offered states extra Medicaid funds as long as they suspended their usual verification and re-enrollment procedures. In other words, anybody on Medicaid would get to stay on it automatically, for the duration of the public health emergency.
The states agreed, and it’s one reason that Medicaid enrollment swelled ― which, in turn, was partly why the number of Americans without health insurance fell to record lows. Now, that arrangement has ended. Once again, states are going through their Medicaid rolls, requiring beneficiaries to reestablish their qualifications to stay on the program.
But just as some states have historically made the enrollment process easier, some are currently going out of their way to minimize coverage losses ― for example, by using existing databases to verify people’s eligibility automatically, when possible. Certain states are going even further by changing their Medicaid programs to make it easier to stay on.
One such state is Oregon, where officials recently worked with President Joe Biden’s administration on a series of Medicaid changes designed to better address poverty. A key element was the introduction of ”continuous” eligibility for young children, meaning that those who get onto Medicaid will automatically stay on the program until they turn 6 years old.
The trade-off is that, almost inevitably, there will be some kids on Medicaid who are no longer eligible or no longer need the coverage ― say, because their parents have gotten better-paying jobs with benefits. Oregon officials evidently figure it’s a small price to pay for helping so many more kids in need.
“The public health emergency has clearly demonstrated the value of having continuous health insurance, particularly for populations that experience health disparities and have had historical barriers to health care access,” said Elizabeth Gharst, a spokesperson for Oregon’s Health Authority, after the change was announced.
But officials in some states don’t have that mentality. One such state is Florida, which last month released its first report on how the Medicaid reverification process was going.
The Medicaid Purge In Florida
The state’s official data showed that, in just a few weeks of reviewing records, Florida had canceled coverage for nearly 250,000 residents.
That’s a lot of people, obviously. But what was perhaps more striking was that this represented 54% of the records it had reviewed. In other words, somebody lost coverage in more than half of all the Medicaid cases that Florida examined.
Last week, the health care research organization KFF published a brief comparing figures from nine states that have begun their review processes in earnest and are reporting figures. Florida’s proportion of disenrollments was the highest. And while a handful of states had similar rates, others were dramatically lower. In Virginia, for example, the rate was just 10%.
It’s impossible to know exactly which Floridians are losing coverage and why. In all likeliness, some truly don’t qualify for Medicaid anymore. But only 18% of those losing coverage in the state were definitively determined to no longer qualify. The rest were disenrolled for “procedural” reasons ― meaning that something in their paperwork was off.
It’s a safe bet, as the KFF brief noted, that many of these people still qualify for Medicaid but just struggled to navigate the documentation requirements and bureaucratic procedures.
Most likely, many will end up with no insurance at all.
Health care advocates in Florida feared precisely this scenario, practically begging the state to go slow on redeterminations and to make sure the process was thorough.
Now that the initial figures are available, 52 organizations have sent a joint letter asking DeSantis’ administration to pause the process so it can set up better notification procedures and increase staff numbers at the agency processing cases. All eight Democrats who represent Florida in the U.S. House of Representatives signed a letter making the same basic plea.
“When governors see such large numbers of terminations of coverage for procedural reasons... they should pause the process and see what is going wrong,” Joan Alker, a Georgetown University research professor who has been following the Medicaid redetermination story for months, said at a virtual press conference in May.
A Window Into A DeSantis Presidency
Conservatives see things differently, arguing that aggressive reviews of Medicaid rolls are a necessary and responsible way to control program costs.
Brian Blase, a former Trump administration official who is now president of the Paragon Health Institute, noted recently in National Review that Medicaid has “retroactive eligibility” ― which means that people who lose coverage can re-enroll, and then submit bills that are up to three months old.
But some states have dramatically scaled back retroactive eligibility. Florida is one of them. And while the state’s officials have defended their approach to reviewing eligibility as sufficiently cautious, yet another KFF survey found that Florida had relatively few systems in place to protect eligible beneficiaries from losing their coverage.
All of which is consistent with the DeSantis record. He has a well-established history of opposing government health care plans, for the same reasons that most conservatives do: He argues they are too costly and wasteful, and that they interfere with the free market by sapping individual initiative.
As a member of the House in 2017, DeSantis voted to support far-reaching efforts to repeal the Affordable Care Act. As Florida’s governor, he has refused to support the ACA’s Medicaid expansion for the state, which is the biggest reason that more than 12% of Floridians don’t have health insurance. That’s the fourth-highest rate in the country.
Exactly what role his thinking played in shaping Florida’s approach to Medicaid redeterminations is an interesting question. The same goes for how DeSantis feels about so many of his residents losing coverage. But he hasn’t addressed the topic publicly, and when HuffPost repeatedly asked about it while first covering this story months ago, his administration didn’t provide answers.
On the presidential campaign trail, DeSantis has generally been appearing in front of friendly audiences and supportive interlocutors. But he’s going to run into sharper questioning eventually. At some point — maybe during the primaries, maybe not until the general election contest — somebody is bound to ask about these huge coverage losses.
As they should. Government health care programs like Medicaid represent a massive commitment of federal funds. They are also a lifeline for a large swath of the population, with the potential to reach even more people who need help.
DeSantis would have a lot to say about this as president. Voters deserve a preview of what that would sound like.