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Florida's Uninsured Health Insurance Mess: Getting a Handle On It

The Florida Legislature reconvenes today in a special session to do its only real job – pass a budget. The impasse, between Republicans in the House and Republicans in the Senate over expanding healthcare for uninsured Floridians, prompted House members to pick up their ball and leave the playground three days before the regular session’s scheduled end. (See Legislatus Interruptus) Now lawmakers have three weeks in June to make up for those three days in April, on the taxpayers’ dime, of course.

At issue is a $4 billion difference between the two chambers. Among other items, senators want to use federal dollars to expand healthcare and keep indigent hospitals afloat. House members do not. Well, that’s not entirely true. House members would willingly take $1.3 billion in federal money to give to hospitals to supplement Medicaid payments, but they flatly refuse the contingent $50 billion for expanding healthcare coverage to the state’s uninsured people.

The Un-Medicaid Medicaid Expansion Program

Don’t call it Medicaid Expansion – much less, Obamacare. Florida Senate President Andy Gardiner, R-Orlando, has hit Florida’s op-ed circuit to argue for the Florida Health Insurance Affordability Exchange Program (FHIX), a “Florida solution” for 800,000 of the state’s low-income, uninsured people. The impasse over healthcare expansion, which the Senate wants but the House does not, is the reason Florida lawmakers return to Tallahassee for a special session on June 1.

Northeast Florida’s Sen. Aaron Bean R-Fernandina Beach has joined the FHIX chorus amending the plan to bypass a temporary one-year Medicaid enrollment in favor of setting up enrollees with private care immediately. Bean’s amendment also ramps up work, school or volunteer requirements (with some exceptions) for participants.

Both Bean and Gardiner refer to “guard rails” that would leave Florida the option of backing out if the federal government doesn’t meet its obligations to the program.

Bean and Gardiner work in Florida’s hospital industry.

While the amended FHIX plan addresses all of the concerns enunciated by Florida house members, house budget chief Richard Corcoran, R-Land O’Lakes, and House Speaker Steve Crisafulli, R-Merritt Island, remain its loudest critics. On May 27, Corcoran retweeted the following tweet from Crisafulli:

“We can’t afford to expand #Medicaid under #Obamacare. RT if you support fiscally responsible healthcare solutions.”
“Every new dollar spent on Medicaid Expansion means LESS MONEY for our children’s education and public safety or HIGHER TAXES to foot the bill.”

A Florida FHIX, to offset a Supreme Court nix?

Although the FHIX program would finally create an online health-insurance exchange for Florida, proponents insist it’s not to be confused with The Affordable Care Act. A Healthy Florida Works, which identifies itself as a coalition of business and community leaders, is running a TV ad in Florida markets that says FHIX is “not Obamacare,” and “not a Washington solution,” but a “Florida solution.

The PR team tweeting for @AHealthyFlWorks emphasizes that the people who would be eligible for FHIX are workers who bake your pizzas, sell shoes at the mall and clean your hotel rooms – they just can’t afford health insurance without the Senate-endorsed plan.

But they’re not the only ones who can’t afford insurance without federal subsidies.

In March, the U.S. Supreme Court heard arguments but has not yet ruled on whether federal insurance subsidies could go to individuals outside of state exchanges. Floridians who have bought health insurance on the exchange so far have done so on the federal system.

If the court rules against the Obama administration in King v. Burwell, Republicans here will be in a pickle as they figure out how to answer to the 900,000 Floridians who’ll get kicked off of their health insurance policies. That’s one reason state senators are struggling to pass a plan – so we’ll have our state exchange up and running to keep federally subsidized insurance going.

Will the Feds give Florida any LIP?

The other reason for rushing to pass FHIX is to keep the doors open at indigent hospitals like UF Health.

The logic is that once FHIX insures an additional 800,000 Floridians, there will be a decreased need for federal, low-income-pool payments (LIP) to keep hospitals that currently serve uninsured people in business. The feds set an expiration date for LIP funds, June 30, and won’t commit to weaning us off of those funds gently – by sending another $1.3 billion – until we do what they’ve asked: expand Medicaid, um, that is, Florida’s privatized un-Medicaid version of Medicaid.

If FHIX is passed, new participants will be able to get their coverage from private providers, just as ACA participants do. FHIX also requires enrollees to pay nominal premiums, about $25 per month at most, a feature which will help Florida offset the subsidy it will need to fund in order to trigger $50 billion in federal dollars for this healthcare expansion.

Gardiner and Bean say that FHIX, which is being marketed as the next step in Medicaid reform, would not resemble traditional Medicaid, and would aim to serve those whose incomes reach up to 138 percent of the federal poverty level. A family of four making $33,465 or less would be eligible for FHIX, as would an individual making $16,242 or less.

The “Charge Master”

Gov. Rick Scott and Republican members of the Florida House have made much ado about the words “Medicaid expansion,” and “Obamacare:” Scott even flew to Washington to beg for $1.3 billion dollars in LIP funds while firmly rejecting $50 billion for healthcare expansion.

Then, Scott went so far as to suggest that hospitals across the state share profits to subsidize hospitals that would otherwise end up operating in the red. To that end, he convened a healthcare commission and ordered the state’s hospitals to disclose their financial data to the body. Scott wants the details on the specific costs of health services, i.e., the “charge master.”

Many hospitals thumbed their noses at his decree, citing confidential price agreements with insurers. Interestingly, officials at HCA – formerly headed by Scott – wrote a letter to the governor suggesting that higher Medicaid reimbursement rates and a tweaked hospital tax structure would offset potential federal LIP losses. There’s no reason, however, that these changes must be mutually exclusive from implementing FHIX, i.e., there’s no reason lawmakers couldn’t do both.

The “Able-bodied adults” argument

So far, proponents of the amended FHIX proposal, which was originally developed in partnership with chambers of commerce and hospitals across Florida, are still trying to outshout the anti-Obamacare mantra emanating from the House.

Meanwhile, as Florida Politics reporter Christine Jordan Sexton reports, Speaker Crisafulli says the feds will never go for FHIX’s “conservative guardrails,” leaving Florida with a “costly and inefficient entitlement program to serve able-bodied, working-age adults with no children.”

Never mind that many of those “able-bodied working-age adults with no children” are working every day in the state’s construction, hospitality and other industries and can’t afford health insurance premiums without expanded subsidies.

Make no mistake: Americans have already decided that we’re not going to turn people in medical crisis away from our emergency room doors. It’s illegal. Embedded deep in our national psyche is the notion that medical care is essential to our most heralded value, equal opportunity. We’ve agreed that it’s hard for a person to pursue happiness when she’s broken, bleeding or walking around with untreated diabetes.

But when it comes to making healthcare for low-income workers more efficient by expanding that national value to include preventive care, uberconservatives like Crisafulli and Corcoran balk. Ensuring that poor workers have the same access to healthcare that lawmakers do, after all, would make it harder for politicians to distinguish poor people as somehow less worthy of the American Dream.

The politics of personal resentment is alive and well and back in Tallahassee. The shortsighted idea, as Morris Dees of the Southern Poverty Law Center describes it, is this: “No one should get anything that only I should be entitled to.” Why else would Crisafulli bring up words like “able-bodied working-age adults”?

Julie Delegal, a University of Florida alumna, is a contributor for Folio Weekly, Jacksonville’s alternative weekly, and writes for the family business, Delegal Law Offices. She lives in Jacksonville. Column courtesy of Context Florida.

This piece was reprinted by the Columbia County Observer with permission or license.

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