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Friday, Nov 17, 2017
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A fair alternative to Medicaid

The Florida House is scheduled to vote today on a Senate plan to expand health insurance opportunities for the working poor, and all indications are Republican House members will meekly go along with their leadership’s unbending and politically driven opposition to the measure.

And that’s shameful. We hope members have the spine to do what’s best for the people of Florida.

The Senate’s thoughtfully crafted plan addresses a serious need and a serious drain on the economy.

It could offer health insurance coverage to as many as 800,000 of the state’s low-income residents, many of them working poor who don’t qualify for Medicaid. Though some estimates put the number of people who would qualify closer to 400,000, it’s still a large portion of the population deserving of coverage.

When they do have to get treatment and can’t pay, the public ends up with the tab as the costs are shifted to those who are insured. It’s estimated treating the uninsured increases health insurance premiums by about $1,500 a year. Yet the House would retain this hidden tax on business.

In contrast, the Senate plan would offer the uninsured health insurance — but would require that they be employed or going to school. Parents would have to meet a minimum requirement of 20 hours per week, and childless adults would have to meet a minimum of 30 hours per week. Exceptions would be made for the disabled or caregivers of a person with disabilities.

Moreover, participants would have to help pay for the coverage. The premiums would be modest — up to $25 a month. Coverage would be suspended for at least six months for those who did not pay.

This is not some free entitlement. People will be held accountable.

The Senate plan, it should be stressed, is far different from the Obamacare plan to expand Medicaid, which promised to pay 100 percent of the costs for three years and then 90 percent after that. Florida already has missed out on that initial year of the feds paying all the costs.

The Senate would use the federal dollars promised for Medicaid expansion for a state-run program — the Florida Health Insurance Affordability Exchange, where those eligible could buy insurance coverage from private insurers.

Early Senate plans called for the uninsured to temporarily enroll in Medicaid before entering the exchange, but to address the House’s objections, Senate President Andy Gardiner and his team reworked the measure. Now participants would go straight into the state exchange on Jan. 1, 2016.

There would be absolutely no expansion of Medicaid, something House members should recognize as a major concession, and one that ensures the state remains in the driver’s seat.

There are other safeguards against federal shenanigans — including a circuit breaker to kill the program if Washington doesn’t keep its commitments, and a requirement that the state approve any major federal change to the program.

House Republicans should see the importance of the legislation calling for the FHIX program to sunset in July 18, 2018, unless re-enacted. Lawmakers will have a chance to review the program and determine its costs and effectiveness before state dollars will be used.

It is possible, as House leaders claim, that the Obama administration won’t accept the Senate’s plan. But the Legislature should make the administration decide whether it cares more about helping the working poor or rejecting the conservative principles that underpin the Senate measure.

Republican House members should look beyond all the political grandstanding, attend the details of the FHIX plan, and approve a measure that would cautiously help the uninsured without giving them or the feds a blank check. Doing nothing should not be an option.

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