pinion Someone In Tallahassee Needs to Make a More Vocal Case for Medicaid Expansion

In what can only be attributed to party-politics, Republicans in the Florida House have been holding up Medicaid expansion and more than $50 billion in federal funding for the 800,000 uninsured in our state. With much more suddenly at stake, Republicans in the Florida Senate (which passed expansion 39-1 in 2013) will have to do more to ensure that their party members in the house see the light.

A program known as the "Low-Income Pool" is being phased out as part of Medicaid expansion, which Florida continues to reject. These funds, which become duplicative under expansion, will cost the state billions if we don't transition to the expansion and accept them in another form. LIP money is paid to "safety net" hospitals, including Manatee Memorial, Blake Medical Center and Sarasota Memorial to offset the cost of paying for those who do not meet Medicaid requirements, but also cannot pay for care. Since most of the latter would qualify under an expanded Medicaid, the funding is being redirected to such ends. It’s also more efficient and contains more accountability when the funding is issued through Medicaid.

These are often people referred to as the working poor, those who have a job (perhaps more than one) but do not get or cannot afford employee-sponsored health care. There are subsidies for low-income individuals and families to purchase coverage via the exchange, but there remains a gap that is intended to be covered by expanding each state’s Medicaid program. It’s an important piece to a complicated puzzle and denying its implementation is nothing more than an attempt to undermine the viability of the Affordable Care Act -- more political games at the expense of the American people.

Hospitals already claim that there is not enough funding to offset the costs of such care. In Manatee County, they led an effort to implement a half-cent sales tax to replace money that used to come from a corpus account created by the county's sale of Manatee Memorial to a for-profit health care company. The corpus has been depleted and the BOCC has continued to kick the can down the road with interim funding from reserves to maintain the status quo. Their only idea seems to be a tax.

That’s an issue in and of itself, but its existence demonstrates the reality that is created when state governments pretend to be bucking big government programs when they are only saddling small governments with unfunded services that they are even less equipped to deal with. The problem does not end with the state legislature’s inaction. Instead, many new problems that are harder to deal with are created. That seems like the opposite of what leadership should result in.

Recently, Senator Bill Galvano (R-Bradenton) gave a speech to a pro-business group in which he indicated that it was critical for the state legislature to accept expansion. Yet House leaders have indicated that they have no intention on even taking up the issue. While it is refreshing to see Galvano call for action among his party (somewhat publicly even), he'll likely have to do much more if he wants to take leadership on the issue.

Democrats are already on board. Governor Scott has flip-flopped on the issue, and while it seems clear that he would not attempt to stand in the way of expansion, it seems equally clear that he will not provide leadership (it wasn’t even mentioned in Tuesday’s State of the State speech). Public opinion and multiple studies support the idea that expansion would be good for the state, ultimately saving it money. Yet, absent real leadership on the issue, it seems doomed to continue to flounder.

The Manatee County Commission (six of seven of whom are also Republicans) were willing to lobby hard for the half-penny sales tax, yet avoided the opportunity to fight for the more efficient solution that would not further burden their local taxpayers by calling on members of their party in Tallahassee to end the political gamesmanship and do the right thing for Floridians. Taxpayers have already sent money to Washington that Washington is trying to send back. We need to accept it before asking taxpayers for more.

The leadership vacuum on this issue has been startling. If the LIP money dries up, it won't just impact the bottom line of local hospitals. Those costs will be passed on to those who do pay for their care by way of higher fees per services and/or higher insurance premiums. We're far past the point where action should have been taken, which is why soft words ring a bit hollow.

There's an opportunity for someone in the Republican Party of Florida to demonstrate real leadership potential, if only by showing that they can get a no-brainer across the goal line. Galvano, who is positioning himself to become Senate President in 2018, has a chance to prove his mettle at least a little bit. He'll just have to show a bit more moxie if it's going to happen. 

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.