Legislature makes Medicaid ‘a giant lingering issue’


Published: Saturday, May 4, 2013 at 8:23 p.m.
Last Modified: Saturday, May 4, 2013 at 8:23 p.m.

Florida lawmakers took on a slate of big issues during the 2013 legislative session and passed some high-profile bills, but one decision threatened to overshadow everything and roil state politics for the foreseeable future: Rejecting expanded health insurance coverage for the poor.

In a busy year that saw teachers receive a pay raise, manufacturers a tax cut and significant reforms to everything from elections law to ethics standards and home foreclosures, the heated debate over Medicaid expansion divided Republicans, energized Democrats and nearly derailed the entire lawmaking process.

House Republicans’ decision not to expand the federally subsidized Medicaid program in Florida leaves roughly 1 million state residents without health insurance and deals a blow to health care providers hoping to boost revenues and reduce charity care.

It also curbs federal spending — the motivating factor for opponents — and ensures Medicaid will remain a critical friction point in Florida politics.

“It’s a giant lingering issue,” said University of South Florida political science professor Susan MacManus.

A deal seemed in reach this year when Republican Gov. Rick Scott — one of the nation’s sharpest critics of President Barack Obama’s health care plan — and Senate Republicans agreed on a plan for taking more than $50 billion in federal funds in a modified version of Medicaid expansion.

But Republicans in the more conservative House firmly opposed accepting the money during the 60-day session that ended Friday, arguing the federal spending is not sustainable.

Frustrated House Democrats tried to pressure their Republican counterparts by invoking a rarely used procedural tactic to stall action on other bills.

It did not work, and political positioning for future elections already has begun.

Scott may have the most at stake. Facing low poll numbers, the governor has moved toward the middle on a variety of issues, including health care reform.

“I can’t in good conscience deny those Floridians access to care when our taxes are already paying for it,” Scott said after the session ended. “But the Legislature said no.”

Yet Scott never campaigned aggressively for the health care expansion — perhaps because he was leery of further alienating conservatives who lambasted his stance — and seems unwilling to push the issue further.

When asked Friday if he would call the Legislature into special session to address Medicaid, Scott said: “The Legislature made their decision. They said no.”

Democratic National Committee Chairwoman Debbie Wasserman Schultz described Scott’s position this week as “sitting on the sidelines trying to have his cake and eat it too.” The South Florida congresswoman said Democrats won’t let Scott “take credit for something that you didn’t actually go down swinging for.”

The issue is likely to figure prominently in Florida’s 2014 elections if lawmakers do nothing again next year.

Democrats made health care and the Medicaid expansion their top priority for the legislative session. They took the extraordinary procedural step of forcing every House bill to be read aloud — slowing action to a crawl in the session’s last days — to protest inaction on the issue. They also turned every bill into a debate on expanding health care.

On legislation involving electronic court filings, Rep. Lori Berman, D-Lantana, said: “Just like we’re doing in this act, we need to do things efficiently and ... that are fiscally responsible and insuring 1.2 million more Floridians is the right thing to do.”

Supporters of Medicaid expansion see it as a moral imperative and a winning political issue, a major turnaround from 2010 when Scott was swept into office campaigning, in part, against Obama’s health care reforms.

MacManus said many Floridians are still skeptical of the health care law and concerned about federal spending. That sentiment has particular weight in House districts, which are smaller and more intensely partisan. Most House Republicans are unlikely to suffer political consequences for opposing Medicaid expansion, she said.

But with the U.S. Supreme Court upholding the Affordable Care Act and passion starting to give way to pragmatism, the issue could be a problem for the GOP in Florida if the public perceives Republican leaders as unreasonable, MacManus said.

“If it looks like their party itself has taken a hit, they get that,” she said. “They’re already worried they’ll lose the governor’s seat. There could be a concern there that the brand itself takes a hit.”

Republicans also risk further energizing Democrats, who already are motivated to beat Scott, MacManus said.

Democrats erupted into sustained applause during caucus meetings this week after long House floor sessions. The Medicaid protest brought a zeal to the caucus not seen in years. That enthusiasm could carry over into campaign season.

“The grassroots movement has already begun,” said Rep. Darryl Rouson, D-St. Petersburg, who is in charge of recruiting and promoting Democratic candidates as the minority leader in waiting.

Rouson said Medicaid animates his caucus because it affects so many lives.

“It is the most critical piece of legislation we could have passed out this year,” Rouson said. “It means life and death in some instances. How do you value life and death? How do you tell someone whose sick and has no insurance we left something on the table that we could have done to give them better health?”

But supporters of Medicaid expansion could be in for a long fight.

It took five years for Florida to join the Medicaid program after it was first created in 1965. Some states waited more than a decade. States can expand Medicaid anytime in the future, but only the first three years are 100 percent federally funded. After that, the rate drops to 90 percent and states must pick up the difference.

Whether the issue is potent enough to stir public discontent and spur lawmakers into action remains to be seen.

A Quinnipiac University poll from March found that 50 percent of Floridians support Medicaid expansion and 40 percent are opposed. But only 26 percent of Republicans support expanding the program and 46 percent of independents, compared to 73 percent of Democrats.

House Speaker Will Weatherford, R-Wesley Chapel, defended his stance on Medicaid, saying the House position was the right one.

Weatherford is speaker again next year. He has been adamant about sticking to a health insurance proposal that is “based on free-market principles and doesn’t take money from the federal government that is unsustainable.”

Pressure to expand Medicaid could grow as supporters are able to highlight the human toll of rejecting the money, the financial impact on health care providers and the potential to create more jobs.

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