TAMPA — Efforts to expand Florida's health insurance for the poor faces an uphill battle in Tallahassee, but advocates appear determined to keep the debate going.
This past spring, Florida legislators declined to expand Medicaid as part of the national rollout of the Affordable Care Act, despite the federal government's offer to pay $51 billion to cover the program for 10 years.
At a Tampa town hall meeting on Wednesday, a Democratic legislator and other Medicaid-expansion supporters challenged a Republican House leader to re-address the problem still facing more than 1 million poor, uninsured Floridians.
“What do we do for these individuals? Do we say they don't exist? Do we walk away from them?” asked former Rep. Mike Fasano, a Republican who now is Pasco County's tax collector. “My hope is that next year, things will change.”
Naples Rep. Matt Hudson, chairman of the House Healthcare Appropriations Subcommittee, said he expects alternative programs will be pitched during the legislative session that starts in March.
But taking federal money to spend on an inefficient and ineffective Medicaid system isn't fiscally responsible, Hudson said, echoing recent statements by House Speaker Will Weatherford.
“It gives me great pause to want to advance something that seems shaky right now,” Hudson said. Hudson said the troubled rollout of the federal government's online insurance exchange and delays to business-related aspects of the law add to his reluctance.
He said Florida also suffers from a shortage of primary care physicians, and constituents in his rural Southwest Florida district have a hard time getting access to a doctor now. Signing people up for Medicaid won't change that reality.
“You can give somebody a fancy little card that says you're in the club, but if there's nobody for them to see, what have you given them?” he said.
St. Petersburg Rep. Dwight Dudley said legislators can ramp up state efforts to recruit primary care physicians and look for creative ways to provide health care to rural residents. Avoiding the issue won't stop people from getting sick and ending up in the hospital, he said.
“People without health insurance are accessing health care through the emergency rooms and we are subsidizing it,” said Dudley, who backs adding to Medicaid individuals who make up to 138 percent of the federal poverty level, which is a little more than $15,000 a year.
Nearly 40 percent of St. Petersburg allergy specialist Mona Mangat's patients already get Medicaid, a highly subsidized health insurance. There's no such option for her uninsured patients, she said, including a 40-year-old college-educated IT consultant who treats his chronic asthma only when he can pay for medications.
When he can't afford his medicine, the man ends up in the hospital for several days, racking up bills that sometimes amount to $20,000, Mangat said. He's unable to pay, and without insurance, he can't break the financially devastating cycle, she said.
“I have nothing to offer him. … He is living on the edge between health and financial security,” Mangat said.
Mangat and Dudley pointed to Republican states such as Michigan and Ohio that have voted to increase the number of Medicaid-eligible residents and accept the federal money meant to cover all costs for the first three years.
“What do we have to do? We need to open our minds, we need to look at what other red states are doing. … We have to help our people,” Dudley said.
Under the health law, Medicaid expansion was designed to cover an estimated 16 million of the 40 million uninsured Americans. And early enrollment reports show that where it's available, those individuals are signing up. This week, 10 state exchanges with Medicaid expansion report they have signed up 444,000 eligible individuals.