THE ISSUE: State legislators again refuse to expand Medicaid coverage.
OUR OPINION: No more excuses — this needs to happen.
As this year’s state legislative session drew to a close, many commenters graded legislators on how well they did on the wide range of topics they considered. They’ve been praised for their progress in a number of areas.
For one of the most basic issues, though, we give them a hard fail. They have shown yet again that current dollars are more important than human well-being and long-term budgetary management.
Year after year, state legislators refuse to seriously consider Medicaid expansion under the Affordable Care Act (ACA). This year, with data from the 38 other states that have expanded Medicaid, plus the needs of so many Floridians thrown out of work due to the pandemic, there’s no excuse for such legislative arrogance.
First, some background. Medicaid is a federal-state program, with coverage rules varying state-to-state. In Florida, Medicaid is available to low-income individuals in certain groups, including children, pregnant women, seniors (can be dual-eligible with Medicare), disabled and a very few other adults.
The original ACA rules mandated state Medicaid expansion, but the U.S. Supreme Court negated that, making expansion voluntary. During the ACA’s first years, the federal government paid 100% of Medicaid expansion to encourage states to be less-restrictive and to open Medicaid enrollment eligibility to those with incomes up to 138% of poverty level. Now, the federal government pays 90%, and the state pays 10%. Medicaid expansion would allow those in poverty who don’t make enough to qualify for subsidies in the insurance marketplace to still get health care coverage.
Every year, Florida’s legislators — who by the way can access taxpayer-paid state health insurance coverage — essentially say, “sorry, can’t help you” to around 1 million uninsured Floridians. They say it would be too much of a drain on the state budget.
We call baloney on that.
The Kaiser Family Foundation summarized data from 404 studies from the 38 Medicaid-expansion states. Findings: Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates; improved access to care, utilization of services, affordability of care and financial security among the lower-income population; and an association between Medicaid expansion and health outcomes.
Florida legislators who blame budget concerns for their inaction should study the experiences from the 38 Medicaid expansion states. The Kaiser report states: “Analyses find effects of expansion on numerous economic outcomes, including state budget savings, revenue gains, and overall economic growth. Multiple studies suggest that expansion can result in state savings by offsetting state costs in other areas. ... Additional studies show that Medicaid expansions result in reductions in uncompensated care costs for hospitals and clinics, and a growing number of studies show an association between expansion and gains in employment as well as growth in the labor market.”
As the Tampa Bay Times noted, the federal government would have given Florida more than $3 billion in incentives over the next two years if it had chosen to expand Medicaid under the ACA. The coverage would have cost about $1.2 billion, leaving the state about $1.8 billion in the black for those years.
Reducing the burden of uncompensated care is critical. The League of Women Voters estimates that under Medicaid expansion, Florida could save more than $57 million. Being able to get treatment for people with chronic disease before it becomes a health emergency is also critical. For example, the hundreds of dollars for a diabetic’s insulin is tiny compared to the thousands in hospital costs when that person ends up in real trouble for lack of medication.
Florida’s voters, who contribute through federal taxes to the Medicaid funding that Florida refuses each year, are generally in favor of Medicaid expansion: an April poll reported in Florida Politics showed that between 54% and 58% of respondents favor it.
No more excuses. Florida needs to adopt Medicaid expansion.
As Mahatma Gandhi famously said, the true measure of any society can be found in how it treats its most vulnerable members.