State Senate leader calls for expanding health care
Published: Wednesday, July 10, 2013 at 10:18 p.m.
Last Modified: Wednesday, July 10, 2013 at 10:18 p.m.
TALLAHASSEE — The federal government's decision to delay until 2015 the requirement that large businesses provide health insurance for workers has stalled any momentum for calling a special session to expand Medicaid coverage for low-income Floridians.
But a top state legislative leader said the Obama administration's decision to back off the mandate — requiring employers with more than 50 workers to provide coverage or face penalties in January — could present an opportunity to develop a more innovative plan to expand health care coverage in Florida.
In an email to state senators last week, Senate President Don Gaetz, R-Niceville, said the delay in a key provision in the Affordable Care Act "sends a refreshing message that the Obama administration now appears more amenable to discussions concerning flexibility regarding federal health care reform."
The federal announcement came just a few days after Gaetz sent a letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius underscoring the need for more flexibility for states like Florida in expanding health care coverage, rather than limiting the expansion to the current constraints in the Medicaid program. He wrote a similar letter to the Florida congressional delegation.
"It would be wrong to conclude that the lack of an expansion decision during the 2013 legislative session means that Florida does not recognize unmet health care needs in this state or lacks a commitment to improvement," Gaetz told Sebelius.
The Senate advanced a Medicaid expansion plan, developed by Sen. Joe Negron, R-Stuart, that would have provided coverage to an additional 1 million Floridians. House leaders rejected a Medicaid expansion and advanced a more limited state-funded plan that would have covered 116,000 Floridians.
Gov. Rick Scott, in a surprising policy reversal, announced his support for a Medicaid expansion in February, although he did not lobby vigorously for the proposal during the 60-day session that ended in early May.
As lawmakers head toward their first committee meetings in September in preparation for the 2014 session, Gaetz said he was asking Sebelius for help in finding more alternatives.
Gaetz said the states should be allowed to develop "a more cautious and gradual approach" to Medicaid expansion, rather than being required to cover all residents who fall under 138 percent of the federal poverty level — $32,499 for a family of four in 2013.
He also asked for more flexibility in "cost sharing" for participants in the program. Gaetz said states "should be able to promote personal responsibility and require a rational amount of financial participation that avoids creating disincentives for work."
And Gaetz said the federal government needs "to streamline" the approval process for proposed innovations in Medicaid coverage.
House leaders have also supported more flexibility in Medicaid spending, although the House has firmly opposed expanding Medicaid under the limits in the current federal health care law.
House Speaker Will Weatherford, R-Wesley Chapel, portrayed the federal government's decision to delay the business mandate as a sign of continuing uncertainty over the law and the long-term ability of Washington to fund it.
"Count on more reversals, changes & unraveling of Obamacare," Weatherford tweeted last week. "There is no way the Feds can make good on their promise."
Weatherford also said he supported U.S. Sen. Marco Rubio's call for the repeal of the federal law, not simply a delay of its requirements.
Rubio followed that up with joint letter with his 45 U.S. Senate Republican colleagues on Wednesday, asking Obama to "permanently delay" the rest of the law "to avoid significant economic harm to American families."
Delaying the January 2014 mandate that large employers have health coverage for their employees — at least temporarily — removed a major incentive for Florida business groups to support the Medicaid expansion.
Business groups, including Associated Industries of Florida and the Florida Chamber of Commerce, had backed the expansion in the 2013 session, knowing expanded Medicaid coverage could help many businesses, like agriculture and hospitality industries, that would have to provide coverage for low-income workers.
Another incentive was that the federal government promised to pay 100 percent of the cost of the expansion for the first three years, with estimates that the expansion would bring some $51 billion in additional health care coverage over the next decade.
Health care advocates say there is still a need for Florida to act quickly on the Medicaid expansion, which would begin in January, including the fact that the major businesses will eventually face the employee-coverage mandate.
"It may be delayed, but it's still going to happen," said Karen Woodall, executive director of the Florida Center for Fiscal and Economic Policy. "There really has been no change in the multiple reasons why Florida should go ahead and bring billions of dollars into our state."
Woodall said the state could lose a year of Medicaid expansion funding if lawmakers delay their decision until next year.
Rep. Mark Pafford, D-West Palm Beach, bristled at the House speaker's argument that the federal government could not be relied upon to fund the Medicaid expansion. "There's no history to back up his claims that the federal government is going to back out," he said.
Pafford, who sits on the House health care appropriations panel, said Florida should be doing more to help its poorest and sickest residents.
"It's preposterous having this discussion about whether or not to help people in poverty," he said.
He also contrasted the lack of agreement on Medicaid expansion with the strong support for tax breaks for manufacturers and other major corporations.
"People came out of the woodwork," Pafford said. "But when it's for helping people in poverty, everybody wants to tuck their heads in the sand or somewhere else."