TALLAHASSEE -- A state Senate panel Tuesday approved a sweeping proposal TO allow Florida to use billions of federal dollars to expand health care coverage to about 800,000 low-income residents -- if it's able to overcome two big hurdles.
The bill (SPB 7044) won the unanimous support of the Senate Health Policy Committee and applause from the audience when it passed.
"It's a watershed day in the Florida Senate and, hopefully, in the Florida Legislature," said Senate Democratic Leader Arthenia Joyner, D-Tampa.
The bill remains a long shot. Even with the support of the influential Associated Industries of Florida and various hospital groups, it is unlikely to be considered by the more conservative Florida House.
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"They're going to have conversations that we probably won't be having over here," House Speaker Steve Crisafulli said Tuesday.
The federal government is another potential stumbling block. The U.S. Centers for Medicare and Medicaid Services, a federal regulatory agency, would have to grant Florida a waiver in order for the state to get the federal funding. And some components in the Senate proposal have been rejected in other states.
Senate Health Policy Chairman Aaron Bean, R-Fernandina Beach, acknowledged the Senate plan has a "snowball's chance" of winning support from the House and the federal government.
"But you know what?" Bean said. "There's a chance to open a dialogue and say what we have to do go forward. I look forward to the conversation."
It wouldn't be the first time. The Republican-dominated Florida Legislature rejected a proposal to expand Medicaid under the Affordable Care Act in 2013.
The plan under consideration now would establish a state-run private insurance exchange available to Florida residents who earn less than $16,000 in annual income, or about $33,000 for a family of four.
There is also a work requirement: 30 hours a week for childless adults and 20 hours a week for parents of children under 18. Unemployed adults could spend that time searching for employment, participating in job-training activities or furthering their education. Disabled adults and their caregivers would be exempt.
Another provision of the bill requires beneficiaries to pay a monthly premium based on their salary. The cost for a single person earning less than 22 percent of the federal poverty level -- or less than $2,589 in annual income -- would be $3 per month. A person earning more than the federal poverty level would pay $25 per month.
Both proposed eligibility requirements are likely to cause problems with the federal government. No other state has received approval to charge premiums to people who live below the poverty line, according to the Kaiser Family Foundation, which does research on health care issues. CMS has rejected other Medicaid expansion proposals with work requirements.
Bean said he believed Florida could be "first on a lot of these issues."
"We're going to ask and have that ongoing negotiation with the federal government," he said.
The proposal found strong support from the public Tuesday with hospital groups, consumer health advocates and business leaders urging its passage at the Senate committee meeting.
"If it were legal, we would be setting off fireworks today, that's how excited we are," Florida League of Women Voters President Deirdre Macnab said.
A spokeswoman for the Associated Industries of Florida, a business lobbying group that pitched a similar plan called A Healthy Florida Works, called the Senate proposal "ground-breaking health care reform."
The conservative Americans for Prosperity opposed the bill as did the James Madison Institute, which promotes limited government.
"We don't need to take the immense risk here," President Bob McClure said, suggesting the federal government might not make good on its funding commitment.
The members of the Senate Health Policy Committee hope to see the bill move quickly, especially with the state health care budget in flux. The state and federal government are trying to negotiate a successor to the $2 billion program known as the Low Income Pool, which helps hospitals treat uninsured, underinsured and Medicaid patients.
Senate leaders see Medicaid expansion as a way to help hospitals defray the costs of uncompensated care.
If lawmakers hoped economists might find extra undiscovered revenue to bail them out, they were out of luck. When economists last met in December to forecast revenue in next year's budget, they calculated a $958 million surplus. On Tuesday, they met again and made only minor adjustments to their earlier estimate.
Senate President Andy Gardiner, R-Orlando, said he asked his fellow senators to build a budget that "reflects the stark reality of our present situation."
"I will not ask senators to vote on a budget that includes promises of substantial funding we may not be able to keep," Gardiner said in a statement.