Get Florida's House in order over Medicaid expansion

May 7, 2013 

While Florida lawmakers celebrated Friday's conclusion of a fairly smooth regular session well orchestrated by Senate President Don Gaetz and House Speaker Will Weatherford, the representatives in the lower chamber failed Florida by rejecting Medicaid money.

Despite the flash of bipartisan sentiment and self-congratulatory back-slapping after the gavel fell, the Medicaid conundrum remained a highly charged partisan issue. Democrats immediately called on Gov. Rick Scott to order the Legislature into a special session to hammer out health care coverage for the state's poor working families.

While the Senate came up with a compromise solution that accepted federal assistance for health care for the poor under the state's terms, obstinate conservatives in the House led by Weatherford refused to cooperate. But two key components of the Patient Protection and Affordable Care Act largely missing in the debate should compel swift reconsideration -- two issues that are vital to the conservative agenda.

By rejecting some $51 billion in federal assistance to expand private health care insurance policies for more than a million Floridians, as the Senate approved, the House put employers on the hook for federal fines.

A provision in the Affordable Care Act places fines on businesses with more than 50 employees working more than 30 hours a week should those companies not provide health insurance. Without Medicaid expansion, those workers are required to either secure coverage from their employers or purchase insurance from a federal health exchange. Should they tap into a federal exchange, their employer is exposed to fines.

Statewide, those fines could reach an estimated $145 million next year. The fine on employers amounts to $2,000 for each worker who turn to the exchange, although the first 30 workers don't count.

In an act of staggering duplicity, the Legislature shielded the state from fines. Lawmakers approved legislation giving health insurance to part-time state workers in order to avoid those Affordable Care Act penalties.

It's no small surprise that the Florida Chamber of Commerce and Associated Industries of Florida, two powerful business organizations, support Medicaid expansion. The health care industry advocates acceptance because of certain job creation. The Republican leadership in the House apparently is not exercising its pro-business bona fides by turning its back on federal assistance.

This is an unintended consequence created by the Supreme Court in ruling mandatory Medicaid expansion unconstitutional. Some 400,000 Floridians eligible for Medicaid under expansion qualify for insurance exchange purchases, thus leaving businesses -- especially larger ones -- vulnerable to federal fines.

And oddly enough, Republicans are to blame.

If the penalties on business aren't enough of a reason to reconsider Medicaid money, then this ought to rile the conservative naysayers on federal assistance: non-citizens with legal permission to reside in Florida but living below the poverty line will be eligible for subsidized insurance under a provision in the Affordable Care Act,

Poor U.S. citizens in the state will be the first casualties in this ideological battle, with the House even expressing disdain for single, childless adults. One GOP lawmaker described that group as too lazy to secure health care insurance. That shameful perspective fails to account for a lack of skills, lower intelligence, disabilities and a host of other reasons for poverty.

Gov. Scott appeared weak on the issue after calling on the Legislature to accept Medicaid expansion before the session began. After that initial show of support, the governor did not advocate strongly enough to have an impact.

Now he has the opportunity to force the issue. With his re-election campaign in the offing and a majority of Florida voters behind Medicaid expansion, the governor should order a special session on the vital issue and work to convince the recalcitrant House that the pluses far outweigh the minuses.

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