Even staunch conservatives are resigned to the fact that the Affordable Care Act will remain the law of the land with President Obama's re-election last week. Finally this week, Florida Gov. Rick Scott joined that reluctant acceptance of reality since the political situation has been settled. Moving forward, pragmatism must be the foremost consideration.
When the U.S. Supreme Court upheld ACA in a ruling over the summer, justices allowed states to opt out of a requirement to expand Medicaid coverage to all low-income citizens in 2014. A defiant Scott joined several other Republican governors in rejecting Medicaid expansion after the ruling. He maintains the coverage will be too costly for the state, even though the federal government would pay all the additional costs for the first three years and 90 percent afterward.
But Floridians are already paying the cost, one way or another, and Scott's position on Medicaid is shortsighted and should be reconsidered. In announcing his decision to accept ACA, the governor did not indicate a change in position on Medicaid.
In the wake of the high court's ruling, Manatee County's three hospitals expressed hope that the measure would ease the burdensome cost of indigent health care -- often in expensive emergency room treatments. Hospitals end up absorbing some of the loss but insured patients pay more to cover some of that cost through higher insurance premiums -- a so-called "hidden health tax."
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A report by the consumer health organization Families USA stated the undisclosed insurance premium surcharge paid by businesses and insured families -- that "hidden tax" -- rose to $1,017 in 2008.
That figure must be considerably higher now that the ranks of uninsured Americans has increased by the millions since then.
The county also contributes to hospitals. But Manatee's indigent care fund is expected to empty out by 2015. County commissioners and health care agencies and experts have been brainstorming ideas to solve this crisis for years now. One recommendation that remains on the table is a half-cent sales tax.
The best option is Medicaid expansion.
Should Florida continue to reject this, the state would be losing billions of dollars in federal funds -- money that Floridians pay into the treasury by way of income taxes.
The state already pays more than $21 billion a year for its Medicaid program, with the federal government paying half the bill. Under ACA, Florida's cost of additional insurance coverage would rise over time but would only be an extra $487 million by the 2020-2021 budget. Compare that with the federal contribution of $4.2 billion.
With hundreds of thousands of uninsured Floridians gaining Medicaid coverage, those residents would not be causing health insurance premiums to increase or hospitals to face steep financial losses.
Across the country, hospitals could be hampered by an increase of more than $53 billion in the costs of uncompensated care by 2019 should states remain defiant about Medicaid expansion, according to a new analysis by the National Association of Public Hospitals and Health Systems. Recent news reports show only six states opting out -- Florida, Texas and Georgia among them -- with another handful likely to join them.
With huge financial losses at safety-net hospitals and higher trickle-down costs to Floridians both looming, can the state afford to turn down billions in federal money?
That's our money anyway. Why should Florida play the role of donor state in this issue?
Three new studies indicate Florida would gain an economic jolt and thousands of new jobs through Medicaid expansion, Health News Florida reports this week.
The money issue aside, unhealthy poor people need care. This is also an investment in a healthier Florida once more people take part in preventive care and avoid costlier treatments.
Admittedly, Medicaid is an expensive program with flaws, just as the Affordable Care Act. Simply saying no is not a solution. Scott stated exactly that in explaining his reversal on ACA. "Let's have a conversation," he also said.
Let's have one on Medicaid, too.