Carl R. Ramey: Medicaid decision was political malpractice


Published: Sunday, June 23, 2013 at 6:01 a.m.
Last Modified: Friday, June 21, 2013 at 4:37 p.m.

At a public forum recently, I posed a question and then listened as my representative in Florida's House of Representatives, Keith Perry of Gainesville, railed against expanding Medicaid — a key component of the nation's new health care law.

His reasoning? Start with a palpable distrust of government, especially federal government. At one point, on another topic, he even said something to the effect that when government protects you it controls you, suggesting that anything beyond warding off crime or external threats might be seen as illegitimate.

Next, in a long, disjointed harangue over coverage, he proceeded to trash everything about the current Medicaid program — ignoring the fact that most medical plans in this country, public-sponsored or private, are costly and inefficient. Yes, Medicaid, designed for our poorest citizens, doesn't begin to match the high level of medical care Perry and his colleagues in the Florida Legislature receive (at the ridiculously low cost of $8.34 monthly), or that most of us receive through more comprehensive employer-sponsored plans.

But that's the point. Medicaid is a basic, low level plan designed to provide only limited coverage to folks who would otherwise go without.

Perry's opposition also stems from a contorted concern over cost. It's not that the federal government's offer isn't sufficiently generous — since it would cover 100 percent of the expansion through 2016, and fund at least 90 percent thereafter.

No, it's that Florida can't afford to put its trust in a national government that may, eventually, go belly-up, leaving the state holding the bag. Can we just stipulate that if this kind of paranoia were even remotely real, we'd have far bigger problems than funding Medicaid?

At this point, let me hasten to add that Rep. Perry doesn't stand alone on this issue. In fact, his hard-core ideological stance is nearly identical to that taken by the entire GOP leadership in Florida's House, starting with Speaker Will Weatherford — who appears dead set against partnering with the federal government on anything associated with President Obama.

For example, in addition to stonewalling on Medicaid expansion, they championed a failed effort to have the Affordable Care Act declared unconstitutional, rejected any role for Florida in setting up the state's insurance exchange under the ACA, and enacted a completely vindictive measure that, temporarily, allows Florida health insurers to charge whatever they want and to then blame the ACA (by notifying policyholders how much their new premiums are adversely impacted by the ACA).

A little background: Medicaid, providing health insurance to extremely low-income Americans since 1965, is a successful program that has been changed several times. Under the ACA, it's being changed again, to cover most adults under age 65 with incomes up to 138 percent of the federal poverty level (only $15,400 for someone single, $32,499 for a family of four). In Florida, this is estimated to include 1.3 million people (the program already covers about 3,400,000).

Despite efforts to discredit it, Medicaid is cheaper than private insurance and operates with lower administrative costs (partly because it doesn't advertise but largely because it's able to use its bargaining power to extract better prices from hospitals and drug companies).

What's so depressing about this episode is that while the House engages in political malpractice, Gov. Rick Scott, Florida's business community, the healthcare industry and even Florida's Senate all support some form of expansion. Unlike members of the House, they recognize the bigger picture: expansion will add jobs to Florida's economy, boost financially strapped hospitals and extend needed coverage to many workers in Florida's vital tourism and agricultural industries.

If you follow a simple creed — based on shrinking government and promoting self-reliance — it's easy to oppose an issue like Medicaid expansion. Who needs further meddling by an untrustworthy government? Why bother crafting practical solutions when the issue can so easily be demagogued?

In the meantime, don't sweat the hypocrisy of accepting federal funds for roads and research but rejecting funds for indigents because, suddenly, the government is unreliable. And, surely, don't be swayed by a recent report by the nonpartisan Rand Corporation concluding that states rejecting Medicaid expansion will wind up paying more for health care coverage than states that do participate.

Hopefully, it will not end this way — with the House triumphant. This newspaper and others have called for a special legislative session to reconsider the issue. That would be a good start, but only if members of the House can rise above their rigid ideology.

Carl R. Ramey, a former Washington, D.C. regulatory attorney, lives in Gainesville.

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