During the seemingly endless debate over what to do in light of the declining resources in its primary indigent healthcare funding source – a corpus created by the sale of a county hospital to private interests – several members of the county commission have made negative comments about Obamacare and its failure to address the issue as promised.

But such attacks betray the reality that it was the Florida Legislature that turned down $51 billion in federal funds that would have put many of those patients onto the Medicaid rolls instead. Not calling them out on it stinks of partisan politics and makes it even harder to believe that this is about poor people's access to health care and not giveaways to special interests.
 
As its corpus funds dwindle, it seems as though Manatee County's strategy on indigent health care is to keep a gun to the proverbial head of its programs, while waiting for citizens to pass the half-cent sales tax that its administration and Manatee Memorial's CEO have been pushing. The money running out might be akin to pointing the gun toward the prisoner's foot and firing a shot. Feel a little pain and know it's only going to get worse. How many poor people have to die before you'll give us our tax and the $23 million that's projected to come with it each year? – only some of which is needed to cover the healthcare shortfall, the rest of which can be used for other priorities.
 
During the run-up to the referendum, many citizens asked why on Earth the BOCC was trying to force through a special off-year election before we were about to embark on the largest expansion of federal health care in our nation's history. Manatee County Commissioner Betsy Benac, on several occasions, made comments about Obamacare (which falls off the Republican commissioner's tongue drenched with such a pejorative connotation as to be almost comical), and her complete lack of faith that it would solve anything, let alone the issue of treating indigents in Manatee County.
 
What Benac and the other commissioners failed to acknowledge was that their fellow Republicans in the Florida legislature turned away the $51 billion in federal funding from the Affordable Care Act that was intended to do just that. The legislature claimed that they didn't want to be on the hook for any future costs, an argument that proved hollow in light of the facts.
 
Medicaid is a state/federal health care program for the poorest of the poor. Participation by states is entirely voluntary. Even still, all 50 states participate, because it's a great deal with the federal government covering about 55 percent of all costs in Florida (much higher in some recent years because of additional stimulus funding).
 
States have tremendous latitude on administering the program and Florida has implemented some of the strictest eligibility guidelines of any state, which is one of the reasons so many legitimately indigent Manatee County residents end up costing county programs so much money. The Affordable Care Act sought to remedy this by requiring states to expand eligibility for Medicaid by raising income limits to a modest 133 percent of the federal poverty level.
 
To achieve this, the federal government would fund 100 percent of the expansion costs for three budget years and then step it down to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent of the costs in 2020 and beyond. The reason for the step-down is that the expansion would decrease costs over time by getting more people covered and reducing states' need to fund their own indigent programs.
 
Governor Rick Scott initially jumped on the populist right-wing bandwagon and with much fanfare. He supported the legislature's refusal to take the money (which by the way does not go back to the treasury or to pay down the national debt, but is simply lost to other states who benefit from Florida's refusal to accept Washington's efforts to give it back some of the tax money the state has sent there). Scott used bad math and flawed assumptions to claim that the expansion would cost Florida too much money once the federal government started stepping down its portion of the costs toward its basement of 90 percent. Facing an upcoming reelection campaign, the governor later flip-flopped on the expansion, though he offered no more than empty rhetoric on accepting the funds, which still hasn't happened.
 
Study after study (conducted not by politicians but experts and based on good math and valid assumptions) showed that expansion would end up not costing but actually saving the state money. How? Mostly because of duplicative state and local indigent health care programs in which the participants would now be covered by Medicaid - programs exactly like the one Manatee County was attempting to fund with a local tax.
 
Of course no Republican either here or in Tallahassee would actually acknowledge this. Through all of the BOCC hemming and hawing it was never suggested that they lobby their friends in the Republican-dominated Florida Legislature to take the money so that they didn't have to tax their local citizens in order to pay for the things the federal government was already willing to spring for.
 
Did the commissioners understand this? It's hard to say. However, they've gotten nowhere with an indigent care sales tax despite a strong push to reconsider the failed referendum this November. So, with state legislators getting set to head back to Tallahassee and begin the vital committee work that will ultimately set the agenda for the upcoming 2015 session, it's a perfect time for the commission to head up there and demand that their party brethren take the federal funding and stop waging purely political battles that small government Republicans like themselves have to pay the price for.

There is of course the possibility that someone could feel that we should reject both the expansion of Medicaid and sustaining the current level of local spending on indigent care once the corpus runs out. That's a valid opinion that many Manatee County conservatives have expressed, and they don't have to bend themselves into a pretzel to argue for it.

So you can be against government involvement in health care or you can be for it, but it would seem impossible to be for the local tax and against the state expansion. That position argues that you'd rather solve the problem of treating indigents who lack financial means through a less-efficiently administered local program on the backs of your local taxpayers, instead of calling for expanding a more efficient one using money your constituents have already paid into the federal treasury and will disappear elsewhere if you don't accept it.

If our local commissioners actually do possess all of their stated compassion for those who lack access to health care services, they should be honored to lobby their fellow Republicans to likewise extend a helping hand, while demonstrating the fiscal prudence of saving the state money in the long term and showing local conservatives that they won't tax them to appease bigger fish in their party stream. Otherwise, taxpayers look around and see former commissioners on hospital boards and current ones with family members who profit from the status quo and find too many red flags to imagine this is simply goodwill.

related:

BOCC Finally Has it Right on Health Care: “We Have No Credibility on This Issue”

Industry is the Big Loser in Florida’s Rejection of Medicaid Expansion

Dennis Maley's column appears every Thursday and Sunday in The Bradenton Times. He can be reached at dennis.maley@thebradentontimes.com. Click here to visit his column archive. Click here to go to his bio page. You can also follow Dennis on Facebook.