Last week's U.S. Supreme Court decision affirming one of the key provisions of the Affordable Care Act should signal Florida that opposition to all things Obamacare is pointless. Florida's governor and House lawmakers should finally realize that ACA is the law of the land, and, as such, abandon the political myth that the federal government will not follow that law and fulfill its obligations.
The state Senate stands as the only reasonable voice in this political wrestling match among Florida Republicans. Once justices announced its 6-4 decision upholding the availability of subsidies on the federal health care exchange and denying the argument that the law only allowed states to operate those marketplaces, Florida Senate President Andy Gardiner embraced the decision. While applauding the fact that 1.3 million Floridians who receive those subsidies will continue to enjoy Obamacare health care, Gardiner, R-Orlando, lamented another hard fact: more than 800,000 working residents fall into ACA's coverage gap because the House and governor refuse to accept federal money under the act's Medicaid expansion provision.
Gov. Rick Scott and House Speaker Steve Crisafulli, R-Merritt Island, are the obstacles to returning billions of dollars in Floridians' tax money from Washington to the Sunshine State to give uninsured workers access to health care insurance policies. These are low and middle income Americans who do not qualify for traditional Medicaid because their earnings are slightly above the federal poverty level while ACA expanded that bar a bit higher.
But those Americans do not qualify for federal subsidies because the law was written to include them but the Supreme Court struck down the mandate that states expand Medicaid, leaving it voluntary.
So Florida is one of 34 states denying citizens access to affordable health care under Medicaid. Instead, those ailing Americans seek treatments at hospital emergency rooms at excessive cost and preventive health care is rare, thus increasing medical costs as conditions unnecessarily worsen.
Florida's Senate crafted a state-specific health care policy that did not simply adopt Medicaid expansion, but put those dollars into private health care policies that also required policy-holder accountability and buy-in -- all to satisfy conservative arguments against Medicaid. Florida's business organizations, hospitals and health insurers supported the Senate proposal, but the Houses stiffened and forced a special legislative session to resolve the impasse. That ended with Senate capitulation to the House.
So instead of a sensible state health insurance policy, the House allocated $400 million this year to fund the federal Low Income Pool, which partially reimburses hospitals and health care providers for the cost of charity care to the uninsured. That money will draw down $1 billion in federal money for LIP, a federal-state-local matching funds program. But the Obama administration has already warned Florida that federal participation will drop to only $600 million in 2016-2017 and then cease thereafter.
That $1 billion figure is down $1.2 billion from the federal aid in 2014-2015. The federal Centers for Medicare and Medicaid Services pointedly told Florida that LIP funds "should not pay for costs that would be covered in a Medicaid expansion"
So instead of accepting billions in federal aid, the House and governor somehow believe it best to spend state tax revenue on an expiring program. The logic there is baffling. What will happen next year?
And two years from now? Will the House agree to covering the entire cost of LIP simply to stand on a what amounts to a phantom principle? The Legislature convenes in January. Is a long-term solution forthcoming?
The House's obstinate political position now includes a new wrinkle, according to one Miami House Republican, Jose Oliva. The real problems, he maintains, is the "hospital industrial complex."
Despite the fact that health care costs are not increasing at the usual historic rate under ACA, this new "monopoly" argument alleges that the consolidation of health care facilities has somehow ginned up spiraling medical bills. Smoke and mirrors are no substitute for sound public policy.
Americans can agree to disagree about the merits of the Affordable Care Act. The law, far from perfect, needs to be reformed.
Today, though, it is the law. Florida should quit denying hundreds of thousands of working but poor residents access to the health care they need to be productive citizens.