The hottest issue of this legislative session has been the question “Will Florida take $50 billion in federal Medicaid funds to cover over 1 million uninsured?” The Senate and governor say yes, while the House says no, no, no.
A lot of people, including Gov. Rick Scott, have been asking the question, “Why not take the money?” Florida takes federal money for roads, education and a host of other things.
While so far every Democrat in the Capitol has favored taking the money, it's not wholly a partisan split because some Republicans want to, as well. It's the House Republican leaders against everyone else: Democrats, Senate Republicans, the governor, Associated Industries of Florida, the Florida Hospital Association, and consumer advocates.
Testimony and debate has been fierce over the past two months at meetings of special panels set up to examine the issue in-depth, as well as the usual committees. In the hearings, when House Republican leaders express opposition to accepting the money, three themes recur:
1) They don't trust the federal government.
"Our budget is replete with situations where the federal government has provided money for programs and then said, 'We're done,' leaving the state with the tab," said Rep. Charles McBurney, R-Jacksonville. "What the government giveth, the government taketh away."
Experts on Medicaid's 48-year history say they don't know of any incidence in which federal officials rolled back their share of funding. They say it's especially unlikely given the spotlight thrust on it now.
2) Opponents despise where the money is coming from: the Affordable Care Act and Medicaid.
Florida Republicans' antipathy toward the ACA has long been known; Florida led a multi-state effort to get the law declared unconstitutional. The effort was unsuccessful with one exception: Medicaid expansion. Since the program is jointly funded and managed, the Supreme Court said states could decide whether to participate.
Traditionally Medicaid in Florida has covered low-income children, frail elderly and disabled adults, and pregnant women. The ACA would provide Florida an estimated $51 billion over the next 10 years to expand Medicaid coverage to about 1.1 million of the lowest-income uninsured.
The first thing the Senate and House Select Committees on the ACA did was to vote not to expand traditional Medicaid. They then began to quarrel over whether to take the federal funds for an alternative that the Obama administration might accept; that effort resulted in Sen. Joe Negron's Healthy Florida plan, which would subsidize enrollment in private insurance plans.
But it would still be Medicaid, in the view of Rep. Richard Corcoran, the House Chairman of the Select Committee on the ACA and chairman of the House Health and Human Services Committee.
He said, “I can tell you right now, I’ll go door to door, I will go in the newspaper on any media, I’ll tell everyone in my district, I will fight with my last breath to keep you off Medicaid and get you on private insurance.’’
House Republicans think they should help only those who are "vulnerable," such as children, the elderly and the disabled. In the discussion over expansion of health coverage, they have added parents of young children. The House plan developed by Corcoran, R-Land O'Lakes, leaves out other adults.
In other words, it leaves out most of the uninsured in Florida who fall under the federal poverty level. Rep. Travis Cummings, R-Orange Park, said the plan was designed that way to provide "the opportunity for a child to be in a stable home with healthy parents and the fact that an able-bodied adult should be able to find work and not rely on an entitlement program.”
Most of those able-bodied adults without insurance have jobs, especially in Florida. It's just that their jobs either don't provide health coverage or don't pay enough for workers to participate.
Quite a few uninsured working Floridians came to Tallahassee to tell legislators they resent the feeling that they're regarded as lazy. One of them was Charles Frazier of Apopka, a nurse's aide who is supporting two children and a cancer-stricken wife.
He said: "Medicaid is not what the media's been saying, just couch potatoes. There are a lot of hard-working people that's been raised the old-fashioned American way, work, make an honest living, pay your taxes and your country will take care of you."
Whether that will happen remains to be seen. The Legislature's last day of the scheduled session is Friday, May 3.