Stakes high for Manatee County as state health care duel winds down

May 2, 2013 

Florida House Republicans' steadfast rejection of billions in federal health care assistance for low-income residents will have terrible consequences on Florida -- and especially Manatee County -- unless the Legislature's lower chamber reverses course in the next two days.

The Senate, which rejected the House's meager alternative to accepting Medicaid expansion money on Tuesday, is a pragmatic approach and a reasonable compromise that pays heed to conservative ideology.

The Senate proposal does not embrace Medicaid expansion per se, but accepts the money so low-income Floridians can purchase insurance on the private market, thus avoiding enrollment in the federal health care program. The plan would cover about 1 million residents.

The House plan would only provide basic coverage to 130,000 people at a cost to Florida taxpayers of up to $300 million annually.

The Senate plan accepts $51 billion over a decade, with the federal government paying 100 percent of the cost the first three years and Florida picking up 10 percent thereafter. Under this plan, the federal assistance would absorb the $430 million annual cost of Florida's Medical Needy program.

The House would have the state expend $300 million plus $430 million annually while the Senate proposal saves those dollars the first three years and then the $430 million annually thereafter -- money that would be used to cover the state's cost of the federal program.

The House's irresponsible plan simply does not add up. But rigid ideology is at play here, not pragmatism.

Gov. Rick Scott, the health care industry and major business organizations endorse the Senate's alternative, modeled after an Arkansas plan approved by a Republican-led legislature.

Arkansas lawmakers expressed concern about one of the unintended consequences of rejecting federal Medicaid expansion -- exposing businesses to tax penalties.

By tying federal dollars to private health insurance for low-income people, Arkansas businesses with more than 50 employees that do not offer health insurance would avoid those Internal Revenue Service penalties under the Affordable Care Act. The federal government has yet to approve the Arkansas alternative to full Medicaid expansion.

The House refuses to embrace this prudent expansion, instead insisting Medicaid is too expensive and the state cannot count on federal assistance in the future -- a baseless fear.

Over in the Senate, though, a bipartisan coalition voted 38-1 Tuesday in favor of an Arkansas plan.

This also puts Manatee County's conundrum with indigent care into sharper perspective.

While some voters hope Obamacare will solve the county's looming crisis in funding indigent care, even if the House comes to its collective senses and accepts Medicaid money, that will not take care of Manatee's entire problem.

Medicaid usually does not charge premiums and co-pays are only $1 to $3 per visit.

The Florida Senate plan includes premiums from $15 to $20 and co-pays of $10 or less -- which would still be out of reach for the poorest of the poor. Those individuals would remain dependent on charity care, all too often in expensive emergency rooms.

Manatee County hospitals write off millions in such care annually, even though Manatee County also pays millions for indigent health care.

The June 18 referendum on a half-cent sales tax increase remains an important part of the equation for covering the costs of charity care -- especially with Florida poised to reject billions in federal assistance.

On Tuesday afternoon House Democrats showed their frustration over the Republican position by demanding every bill be read in full before discussion, putting the chamber into gridlock.

If the Legislature ends up rejecting federal health care assistance, taxpayers will bear the brunt of this foolish policy. We'll have the House to blame unless representatives overcome their unreasonable position before Friday's adjournment.

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