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Budget Deadline Nears, Stalemate Continues

Apr 28, 2015
Originally published on April 28, 2015 9:01 am

The Florida Legislature will end its annual session Friday, but legislators still have not reached a deal on a new budget. That's because the Republican-controlled House and Senate are at odds about health care, including whether to accept federal money linked to President Barack Obama's health overhaul.

Here's a look at what's going on and what may happen next:

  What caused the stalemate?

Florida wants the federal government to give it $1 billion a year for hospitals that care for patients who are uninsured or on Medicaid. This is also known as the low-income pool or LIP. The feds want Florida to expand Medicaid insurance to more than 800,000 low-income Floridians as part of the agreement to extend the hospital funds, which is part of the Affordable Care Act also known as Obamacare. But Florida Gov. Rick Scott and House Republicans are adamantly opposed to expanding Medicaid.

What will happen after Friday?

Nothing at first. The state fiscal year does not end until June 30. But the pressure will mount for legislators to pass a budget to avoid a potential shutdown of state government.

Lawmakers could extend their current session to work out a deal. But with no agreement in place, it's more likely that the Legislature will have to hold a special session sometime in the next two months to pass a budget. Scott has said he will call legislators back to town if they adjourn without passing a budget. Legislative leaders can also call a special session, but there has to be an agreement between the House speaker and Senate president.

Senate President Andy Gardiner says he will not allow a shutdown, but he also wants the extra time so Florida can find out whether the federal government plans to eliminate the hospital funding altogether or gives the state a smaller amount.

What Is LIP?

The low-income pool, also known as LIP, is a pot of money that the federal government gives nine states to help hospitals that care for patients who are on Medicaid or uninsured. The money is given through a waiver, and the federal government has broad discretion on whether or not to grant the funds.

Florida's LIP money is the first to expire on June 30, but other states are watching closely to see what the federal government decides and how their funds may be affected. Florida has sent a proposal to renew the funding, but federal officials are not obligated to render a decision by the time the state's fiscal year ends.

Why is the administration insistent on expanding Medicaid?

The federal government says they want taxpayers to get the best bang for their buck. They say it's much more cost-effective to help people buy insurance directly instead of paying hospitals for caring for the uninsured after the fact.

Why are Scott and House Republicans against Medicaid expansion?

The governor and House Republicans say Medicaid is a broken program that does not improve health outcomes. They also are worried that the federal government won't make good on its promise to pay the cost of expanding Medicaid, leaving the state on the hook for billions of dollars. The federal government has said it will never pay less than 90 percent of the bill.

What has the Senate proposed?

Gardiner and Senate leaders have proposed expanding the state's Medicaid program this year, but they want to use the federal money to pay for a program where 800,000 Floridians would receive private insurance. Recipients would have to work and attend school, and pay a small monthly premium.

Is Scott suing the Obama administration?

Scott announced this month that he would sue the federal government because he says they are holding the state hostage by forcing them to expand Medicaid. However, Scott has not yet filed the suit and has declined to say when he will.

What will happen if the state doesn't expand Medicaid?

The federal government has said it wants Medicaid expansion if it's going to extend the hospital funds, but experts don't think the Obama administration will immediately yank all the money even if Florida doesn't do that. Florida hospital officials have said they need both Medicaid expansion money and LIP to survive. Several hospitals have said they will be forced to cut services or close without the LIP funds.