Good news: Florida legislature halts Medicaid expansion


Yesterday, in a piece entitled “Florida rejects Medicaid expansion, leaves 1 million uninsured,” the Wonk Blog’s Sarah Kliff reported that Florida’s legislature did what Governor Rick Scott would not – halt Medicaid expansion in the state:

Scott wouldn’t be the one to “deny Floridians” a part of the health care law—but the Florida legislature had other plans. Lawmakers adjourned Friday after passing a budget that does not include funding for a Medicaid expansion. Unless the Republican-controlled legislature comes back for a special session later this year—which some Democrats are calling for—Florida will not expand Medicaid in 2014.

Kliff notes this is happening in other states where GOP Governors have broken with principle:

This isn’t a phenomenon reserved to Florida. In Ohio, Gov. John Kasich (R) is having trouble moving the Medicaid expansion he supported through the state’s Republican controlled-legislature. Similar fights are playing out in Arizona and Michigan, where Republican governors find themselves in the relatively odd position of trying to sell Obamacare to state legislators of their own party.

As she closes her piece, Kliff insinuates legislators abandoned their constituents:

In a way, this is a bit surprising. No one ever expected to hear Scott extoll the benefits of President Obama’s signature legislative accomplishment. That being said, the Medicaid expansion is a really big deal for state budgets—the budget that Scott is charged with overseeing. If his state had participated in the Medicaid expansion, the Urban Institute estimated it would bring $66 billion of federal funds into the state over the course of a decade.

That same burden doesn’t rest so heavy on state legislators. States and hospitals tend to cover much of the country’s uncompensated care and unpaid medical bills. Meanwhile, state legislators have faced intense pressure over this vote. In Ohio, my colleague Sandhya Somashekar reported on one group that went door-to-door collecting signatures from voters pledging to thwart reelection efforts should lawmakers there vote to expand Medicaid.

Why would Florida legislators oppose bringing $66 billion into their state in order to help Floridians who would benefit from Medicaid? Perhaps because it almost certainly wouldn’t help Floridians in the final calculation, and could in fact cause a great deal of harm to the state’s finances. From the closing of my brief analysis opposing GOP gubernatorial support for Medicaid expansion in March 2013:

These governors can claim all they want to that they are helping their states’ poorest citizens by expanding Medicaid. In reality, they are simply setting up patients across all age groups for long lines, a lack of care, and eventually an implosion of the entire American health care system – an implosion exacerbated by the Affordable Care Act. They should be ashamed of their surrender to the federal bureaucracy, and prepare themselves for principled Tea Party opposition if they continue on this path.

In short, Medicaid expansion is going to create longer lines in an already overburdened system. To help cover the costs of this for providers, the federal government will increase Medicaid reimbursement rates. This will likely impact Medicare recipients, pitting Grandma against Grandkid. Then, the federal government plans to precipitously drop reimbursement rates two years later. As I phrased it at the time:

Which means the long lines will continue, as more people are in Medicaid but not receiving care, and care will diminish….

CMS projects that if Obamacare is fully implemented, Medicare reimbursement rates would drop to 26 percent of private health insurers by 2080, and Medicaid reimbursements would continue to hover around 60 percent of private insurers. CMS also estimated in 2010 that 15 percent “of hospitals, skilled nursing facilities, and home health agencies” would have “negative total facility losses” of 25 percent by 2030 and 40 percent by 2050.

In other words, CMS expects all of the major federal health care programs to lower reimbursement rates drastically and/or cause providers to lose money.

Kliff has long held a bias in her reporting – for example, she called the infamous Gosnell trial in Pennsylvania a “local crime” to justify why she did no reporting on it, yet she wrote a gun control post on the “local crime” of the shooting in Newtown – but this particular post is rather telling. Rather than provide two sides to the story on a site calling itself a place for wonks – i.e. people “who [study] a subject or issue in an excessively assiduous and thorough manner,” Kliff merely repeats the big government line of how less federal intrusion in states is a bad thing.

Pass on the word – by standing against the Obama and Scott Administrations, Florida’s legislature has done a good thing for their constituents, and a good thing for the nation overall.