So it turns out that despite Florida lawmakers' sustained campaign to pretend that it's evil to participate in a federal program that subsidizes health insurance for the state's poor, powerful business interests in the state have decided that it's time Florida participates in a federal program that subsidizes health insurance for the state's poor.
Florida has been one of America's breakaway republics when it comes to health care. The state led the unsuccessful suit against the Affordable Care Act, and once that failed, Florida refused to set up a state exchange under the Obamacare law and rejected federal dollars that would have subsidized health insurance for nearly 1 million Floridians.
These are the working poor who make too much money to be covered by Medicaid, but not enough money to qualify for government subsidies to purchase private insurance through an Obamacare exchange.
By not electing to take an estimated $5 billion a year from the federal government in an Obamacare option that expands Medicaid coverage to Floridians in this coverage gap, state lawmakers have tacitly allowed the burden of these unpaid medical costs to fall on the shoulders of state businesses and medical providers.
And to make matters worse, with the Medicaid expansion swallowing up the costs of this care in states that elected to expand Medicaid, the federal government is offsetting this new spending by cutting payments to hospitals for indigent care.
That means that the federal Low Income Pool will slash about $1.8 billion a year in payments to Florida hospitals as these hospitals continue to provide uncompensated care for people who could be insured by Medicaid, but aren't because of the state's political imperative.
Price of obstructionism
Florida's businesses would also be paying a hefty price for this obstructionism.
Next year, the Obamacare law starts requiring businesses with more than 50 employees to provide health insurance or pay a $3,000-per-worker penalty. By turning down the chance to provide health insurance for some of these workers, lawmakers are passing these costs onto businesses.
So while state lawmakers are rooted in their Obamacare obstructionism, a new organization that includes the Associated Industries of Florida, the Florida United Business Association, the South Florida Hospital and Healthcare Association, the Florida Pediatric Society, and the Florida Hospital Association have been staging a legislative intervention.
The campaign is called "A Healthy Florida Works" -- a repackaging designed to give Florida lawmakers the political cover to participate in the national health care law under a different name.
"I've been a lifelong Republican and that's always been my view, for government to get out of the way," said Jamie Harden, a member of the Greater Tampa Chamber of Commerce, in one of the "A Healthy Florida Works" videos. "But in this case, we have to do something to deal with these costs. We have to do something to take care of the people that cannot afford the health insurance they need."
Instead of Medicaid expansion, "A Healthy Florida Works" would use federal subsidies to fund a program that requires people in this coverage gap to buy private insurance at an online health insurance exchange. The people participating have to enroll in job and education training and pay premiums that are invested into personal accounts.
So it has some free-market talking points, enough to obscure the central fact that it hinges on recovering the $5 billion a year in federal health care subsidies from Obamacare.
With the big business interests in the state smarting over Obamacare obstructionism, it's amazing how easy it is to recast federal government efforts to expand insurance coverage as the right thing to do.
Or as the unnamed mother of three puts it another "A Healthy Florida Works" video: "As a working single mom, I am doing everything I can to provide for my kids, and the last thing I need to worry about is how to afford health insurance."
Frank Cerabino, writes for The Palm Beach Post. E-mail: firstname.lastname@example.org.