Republicans in the Florida House are trying to come up with a plan for the uninsured, something they believe would be better than expanding Medicaid.
But flirting with other options could jeopardize billions of federal dollars. And there are no guarantees the Legislature and Gov. Rick Scott will be able to agree on an alternative, or if it would produce better health outcomes for roughly 900,000 of the state's poorest residents.
Rep. Richard Corcoran, chairman of the House committee that voted Monday against expanding Medicaid, has pledged to come up with a solution but admits he doesn't have a plan or even a clear idea of what direction the state should go.
He likened it to the process of building a house. Right now, he is surveying the land and trying to find the right spot to lay the foundation.
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"There's a ton of ideas swirling around," said Corcoran, a Trinity Republican. "It seems that I can't talk to a member or senator that doesn't have one."
For many Republican lawmakers skeptical of Medicaid expansion, Arkansas Gov. Mike Beebe's announcement over the weekend solidified their opposition. Beebe said the federal government had granted his state permission to use Medicaid expansion dollars to purchase private insurance policies for the uninsured on the health exchange.
It was a "game changer" that emboldened Corcoran and others to be innovative.
Last month, Scott came out in favor of Medicaid expansion and he has not wavered. The Florida Senate has indicated it would go along with the governor's proposal to accept federal dollars to expand Medicaid at least for the first three years when 100 percent of the costs are covered.
That puts pressure on the House to provide an alternative. But senators have started doing research, too.
"As you know this is uncharted territory, and we are still trying to understand what options are available," said Katie Betta, a spokeswoman for Senate President Don Gaetz, via email. "Most recently, we have been reviewing and trying to learn more about the reported flexibility provided to states like Indiana and Arkansas."
Lawmakers are both intrigued and a bit worried about the flexibility granted to Arkansas. Policies on health exchanges cost more than Medicaid Ã¢â¢
â an average of $9,000 compared to $6,000 Ã¢â¢
â and the costs both to the state and federal government for the Arkansas plan could inflate current estimates. Arkansas hasn't finalized its proposal, which requires approval from the U.S. Department of Health and Human Services.
Indiana lawmakers have said they won't expand Medicaid unless the federal government allows them to use their own health savings account-based "Healthy Indiana Plan." In Iowa, Gov. Terry Branstad has floated the idea of beefing up the state's low-benefit safety net program called IowaCare.
Corcoran is open to just about anything, as long as it's not Medicaid. He believes people would be better served by obtaining insurance on the private market.
He doesn't think the potential loss of federal dollars should be the deciding factor in how Florida proceeds. If lawmakers come up with a program that is affordable in the long run and doesn't overtax existing resources he would agree to it even if that means Florida forfeits that money, he said Wednesday.
Updated state estimates are expected today, but the amount the state could receive for expanding Medicaid is more than $20Ã¢Â billion in the first 10 years. By comparison, the state's share would be about $3Ã¢Â billion.
Florida Hospital Association president Bruce Rueben has been trying to study up on the Arkansas plan so that his organization can decide whether it would support something similar in Florida. The group is lobbying in favor of Medicaid expansion because hospitals agreed to other funding cuts as a trade-off.
"By all means, take a look at it," Rueben said of the Arkansas plan. "The key is to get people covered. We have a window of opportunity for three years in which 100 percent of the financing for this extended coverage will come from federal tax dollars."
Florida lawmakers have no timeline for when to have new recommendations in place. The 60-day legislative session began Tuesday, but if they don't meet that deadline there is the possibility of a special session.
Even if Republicans, who control both chambers, reach an agreement, there are no guarantees Scott will come along. In an exclusive interview with the Times/Herald Wednesday, the governor did not say whether he would support any alternatives to Medicaid expansion in light of the strong opposition in the House.
"We're having a conversation. I was clear about what I will do," Scott said. "It's going to go through a process and this is just the beginning."
When asked about the Arkansas plan specifically, he refused to bite. "We'll see what they come out with," Scott said.
There is also a chance the House ultimately embraces Scott's Medicaid expansion proposal. Speaking to the Florida Chamber of Commerce on Wednesday, Chief Financial Officer Jeff Atwater said Florida and other states may eventually agree to some form of Medicaid expansion.
Atwater, who has criticized Scott's expansion proposal, said that the state was in a "really tough spot." Growing Medicaid will bring additional costs, but not accepting the federal money could have steep consequences as well because of the hospital cuts, he said.
"I believe they're going to pass (on the expansion) Ã¢â¢
â that's my take," he said. "And then I think, as the stresses begin to fall like, again, (Low Income Pool money for safety nets) being diminished, this is going to cause great stress to that choice. And, I don't know, the inevitable, it may be, no matter what people think, happens."
Times researcher Natalie Watson and Times/Herald staff writers Steve Bousquet and Toluse Olorunnipa contributed to this report. Contact Tia Mitchell at tmitchelltampabay.com or (850) 224-7263.