Gov. Rick Scott and the legislative opponents to the Affordable Care Act dodged a bullet Thursday when the U.S. Supreme Court upheld the federal health insurance subsidies, but it did little to narrow the divide between Republicans over how to handle Florida’s uninsured.
The ruling reduces the pressure on state leaders to create a state exchange to cover the 1.3 million low- and middle-income Floridians who now rely on the federal program for health insurance. But it leaves unanswered the question of how Florida will handle the loss of $400 million federal Low Income Pool money used to reimburse hospitals and health care providers who provide charity care to the uninsured.
After a bitter and divisive legislative session that led to a special budget session ending last week, lawmakers must return in January to craft a new budget for 2016-17 that addresses the loss of the LIP funds. The federal government confirmed this week that it would limit Florida’s LIP money to $1 billion to help cover the cost of the uninsured not covered under Obamacare, for the 2015-16 budget year. But it also said the state’s LIP money would be limited to only $600 million in 2016-17.
That has prompted Republicans in the Florida Senate to renew calls for the state to create an alternative, privately run plan to draw down federal money to cover an estimated 800,000 uninsured Floridians. Florida was among the 34 states that allowed the federal government to run the insurance marketplace, known as exchanges, that allow eligible Floridians to shop for individual health plans.
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But thousands of low-income adults who would be eligible for Medicaid under expansion remain in the “coverage gap.”
Scott and the Republican leaders in the House opposed the Senate’s efforts to create the plan this year. They argued it would prop up a “broken” Medicaid system, expand the federal deficit and hurt taxpayers.
The issue deeply divided the two chambers, as Scott and House leaders accused several senators, including Senate President Andy Gardiner, R-Orlando, who works for an Orlando hospital, of using his office to advocate for his industry.
On Thursday, comment from both sides indicated the feuding is likely to continue.
Gardiner praised the U.S. Supreme Court ruling Thursday and signaled that he was prepared to work “to craft a compromise” with Scott and Republican leaders in the House.
“The Senate remains committed to addressing this serious health care problem through a free-market Florida solution that maximizes consumer choice and personal responsibility, while protecting state sovereignty,'' Gardiner said in a statement.
Scott and Attorney General Pam Bondi would not comment on the ruling but used the opportunity to call Obamacare a bad law.
House Speaker Steve Crisafulli, R-Merritt Island, and House Appropriations Chairman Rep. Richard Corcoran, R-Land O’Lakes, would not respond to requests for comment. But Rep. Jose Oliva, R-Miami, said he expects the House to continue to opposing Medicaid expansion.
“The ruling doesn’t change a thing,’’ Oliva told the Herald/Times. “Now that we know the 1.4 million or so can continue getting subsidies from the exchange, that is a moot point. But it doesn’t speak to the real problem — the problem of hospital monopolies.’’
He said that the problem facing the nation regarding health care is the "hospital industrial complex" which has consolidated ownership of health care facilities, has locked in spiraling costs and does not operate transparently.
He said the House will continue to advocate for reforms — such as removing the requirements for hospital certificate of need and allowing for surgery centers to compete with hospitals. But, in a sign of how bitter and personal the debate has become, Oliva said, he is not confident the Senate will be willing to compromise until after next year when Gardiner’s term expires.
“When someone’s true interest is not lowering health care costs but benefitting an industry they benefit from, how could I have hope in that?’’ he said. “Thankfully, with terms limits it will work itself out. Hopefully we can work with future leaders and push it forward.”