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Friday, Oct 20, 2017
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The challenge after saying no

Florida's Republican-dominated Senate and House surprised no one when its leaders said no to Obamacare's Medicaid expansion, which would have provided health care coverage for an additional 1 million of the state's poor citizens. Now it's up to legislators to implement an alternative program to serve these needy Floridians. That will require more than the sloganeering that so frequently surrounds this issue. The Senate, at least, appears serious about the task. It offers a promising if sketchy plan that we hope evolves into a viable option. Under the rejected plan, the federal government promised to pay 100 percent of the Medicaid expansion's costs for the first three years and 90 percent after that.
Economists estimated the federal government would contribute $51 billion for those Medicaid costs over 10 years under the deal, while the state would spend about $5.5 billion. The numbers looked appealing, particularly when Gov. Rick Scott reached an agreement with the feds that would have allowed Florida to pull out of the deal after three years if it appeared the state would face greater-than-expected costs. Yet Scott, whose health care background gives him credibility on the matter, never detailed why the federal Medicaid expansion was Florida's best choice. Lawmakers, understandably, could not bring themselves to go along with a program that hinges on the promises of a deficit-riddled government already contending with more entitlements than it can afford. Given Washington's ever-changing political landscape, it's not unreasonable for legislators to worry that the administration's promises might not hold up over the years. Legislators also recognized that once Medicaid was expanded, it would be politically daunting to drop coverage for a million people — even if the feds broke their promises. Yet by rejecting the deal, lawmakers leave at risk poor and disabled citizens, and especially uninsured workers. Moreover, there are considerable costs to the status quo. Hospitals end up shouldering much of the costs of caring for the uninsured, and those expenses are ultimately passed on to people who have insurance. Associated Industries of Florida estimates this cost-shifting represents a $1.2 billion "hidden tax" on Florida businesses. So lawmakers need to do more than just say no. Sen. Joe Negron, head of the Senate committee that reviewed the Medicaid proposal, proposes to establish a basic health insurance plan for the 1 million uninsured that would require recipients to pay premiums based on their income — a reasonable concept. Negron envisions doing this by expanding Florida Healthy Kids, a well-regarded health-care exchange for low-income children. Negron's plan would allow uninsured adults to join it and choose among various private insurance plans. With such coverage, participants would have, as politicians like to say, "skin in the game," and, the theory goes, be more thoughtful about their health care choices and expenses. But this scenario likely would still require the use of federal dollars, and there is no guarantee Washington would approve such an arrangement. The administration has signaled it will allow Arkansas to pursue a plan using private insurers, so there is some cause for optimism. Yet even if President Obama's team complies, it is not clear how much this scenario would cost the state. Some legislators are talking about using state funds to help pay insurance premiums for the poor. Lawmakers need to show whatever plan they come up with would be more economical, and effective, than the Medicaid expansion. It makes no sense to drive up state costs just to poke the feds in the eye. There is a lot to figure out and less than two months left in the session. We don't blame lawmakers for not wanting to become entangled in another Big Government effort. But the draining costs for the uninsured are not going to disappear. Lawmakers need to prove they can come up with a superior, more conservative, approach.
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