This week, a majority of Manatee County Commissioners balked at the idea of asking the state legislature to accept Medicaid expansion in an effort to provide relief to the county as it runs out of funding in its indigent care corpus. This says that commissioners either don't understand the issue, or are less concerned with caring for the indigent than padding the bottom line of private sector hospitals.

Florida has now rejected $54 million in federal funding to expand Medicaid as part of the Affordable Care Act. This has clearly been a political move by a Republican-dominated legislature aimed at crippling a key component of a Democratic initiative. This is best evidenced by that legislature completely ignoring its initial promise to come up with their own in-state solution to deal with the nearly one million Floridians who lack health insurance and help drive up the total cost of care by delaying early treatment and presenting at more advanced stages in the most expensive venue – emergency rooms.

The argument the legislature used for refusing the money was that there were too many unknowns regarding expenses and how much the programs would cost the state. Governor Rick Scott used completely fabricated math to try and make this case but was called on it. The “it will cost too much” argument has had more holes shot in it than a downrange target at a third-world rifle-range, with every single study showing that expansion would save the state money.

On Tuesday, Manatee County Commissioner Carol Whitmore, who is embattled in a tough re-election campaign, again wondered aloud whether the board should include Medicaid expansion on its wish list of legislative priorities – a non-binding document it gives to Manatee County representatives in the state House and Senate prior to the annual legislative session. She found little support from her fellow Republicans and didn’t push the issue.

Commissioner Betsy Benac was the loudest voice of opposition. Benac again pointed to the bogus unknown costs argument, and the $23 million the state pays for its share of Medicaid today.

Once more, here's a little primer: Medicaid is a state/federal health care program to cover those who cannot afford even the most basic health care coverage. All 50 states participate in the voluntary program. Why wouldn't they? The federal government covers about 55 percent of all costs, and the more people who are covered by some sort of plan, the less expensive health care becomes for everyone.

Florida has the second stingiest eligibility guidelines, which is one of the reasons so many legitimately indigent Floridians don't qualify and end up costing the state and municipalities through other less-efficient programs – like our indigent care corpus!

The ACA sought to remedy this by requiring states to expand eligibility for Medicaid, raising income limits to a modest 133 percent of the federal poverty level, which is still a measly $31,720.50 for a family of 4! That’s the “expansion” we’re talking about here.

As part of the deal, 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 the need for other duplicative programs – like our indigent care corpus!

The failed effort of county commissioners to sneak the half-cent local sales tax past voters in an off-year special election was championed by Whitmore, and it's been a liability for her in this election. She wondered aloud whether they should be asking the state legislature back in May as well. That time, she also got the cold shoulder from her fellow Republicans and again, didn't press the issue.

On The Morning Edge radio show Friday, Whitmore said that she’s met privately with Senator Galvano and other state-level officials and will continue to work toward finding funding sources. She stopped short, however, when asked if she disagreed with her Republican Party’s position, and that best exemplifies the real problem. Republicans are too afraid of their base and party bosses, and lack the political courage to take a stand because they know what their party does to those who don't toe the line.

Instead, they talk out of both sides of their mouths about how much they want to help the needy, while the party works against the programs that actually would. In the end, the BOCC reluctantly agreed to put something on their “wish list” about helping to find an indigent care solution, without mentioning Medicaid expansion or anything that would offer any sort of specificity whatsoever.

So, here's how this breaks down. The majority of your commissioners think that it's okay to tax you $23 million by raising sales taxes to pay for indigent care programs, many of which would be covered by taxes you've already paid, were the state to accept the federal money to expand Medicaid. But they don't think it's okay to pressure the state to accept the tax money we've already sent to Washington and they're trying to return to us, even though it will make much of the local spending unnecessary.

Let's suppose all of these credible studies are wrong and expanding Medicaid does cost the state some money. Where do most of the state's revenues come from? Sales tax! The only difference is that at the state level, the money would be spent more efficiently, through a larger and more accountable program, rather than being doled out by local politicians to local special interests. It makes you wonder what this is really all about.

Look at UHS's financials. Even when you deduct $59 million in “doubtful billings,” which figures the inflated number they bill out, not their actual loss, they're sporting over $21 million in local profits. Sure, they'd like us to help pad that bottom line and for some reason the administration and most of our commissioners are eager to help them. But if they won't even “wish” for expanded Medicaid, let alone demand it, in order to help save local taxpayers from the $23 million tax increase that Commissioners Whitmore, Bustle, Benac, Baugh and Chappie supported in the quarter-million dollar special election, I'd say they still lack credibility.

Forget wish lists. Forget private meetings. The county commission should be marching up to Tallahassee with TV crews behind them, shaming our state legislature into using the tax money we have already paid to help those who are suffering.

Commissioner Whitmore is pretty liberal in issuing her famous “shame on you” denunciation. If she cares so much about those with less, she should cast a few on the members of her party who are keeping those resources from helping them. But asking for more taxes from your local citizens before you've fought to use the ones they've already paid is neither fiscally conservative nor generous to those who have less.

My advice to Commissioner Whitmore is pick a side and get on it. Your citizens have no use for those who straddle the fence and lack the political courage to rock the Republican boat. Commissioner Whitmore has mentioned in every stump speech on this campaign how decades ago she had the courage to join the AIDS Council when it “wasn't a politically popular thing to do.” She should have no problem summoning that same courage and being the Republican who will demand that her party leaders accept the federal funding and expand Medicaid, then calling out her fellow Republicans who represent us in the legislature to do the same.

related:

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

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.