With some Republicans saying they didn't want to expand a "broken" system, a Senate select committee Monday rejected adding hundreds of thousands of Floridians to the Medicaid program under the federal Affordable Care Act.
Senators, however, said they want to pursue an alternative plan that would use federal money to help uninsured low-income people get coverage through private insurers. The select committee's vote came a week after a House panel also rejected the Medicaid expansion --- despite Gov. Rick Scott's support for the idea.
"I oppose the Washington plan, and I want a Florida plan,'' said Sen. Joe Negron, a Stuart Republican who is chairman of the select committee and presented the alternative. "I think we have an opportunity to build a better program than what Washington is trying to force on us."
The committee rejected the expansion in a 7-4 vote along party lines. Democrats said the Affordable Care Act, sometimes called Obamacare, offered a chance to help hundreds of thousands of people get health coverage.
"We have a moral and economic responsibility to seize this moment for the good of Floridians,'' said Sen. Eleanor Sobel, a Hollywood Democrat and vice-chairwoman of the select committee.
The chances of the Republican-dominated Legislature approving the Medicaid expansion dimmed last week when House Speaker Will Weatherford, R-Wesley Chapel, and a House select committee publicly opposed it. But senators had not taken a formal position until Monday's vote.
Weatherford issued a statement praising the Senate move and vowing to work on seeking other options for offering health coverage to the state's uninsured. The House speaker, in part, has questioned the future expense to the state of a Medicaid expansion --- though the federal government says it will pay all of the expansion costs during the first three years.
"I look forward to working with Senate President (Don) Gaetz as we investigate alternatives that will strengthen the safety net while also ensuring that we do not put future funding for our schools, public safety and protection of our beaches and springs at risk,'' Weatherford said.
Scott, whose support of Medicaid expansion was harshly criticized by some conservative supporters, issued a brief statement saying he is "confident that the Legislature will do the right thing and find a way to protect taxpayers and the uninsured in our state while the new health-care law provides 100 percent federal funding."
The Affordable Care Act, which President Obama and congressional Democrats approved in 2010, calls for expanding Medicaid eligibility as a key part of its goal to provide health coverage to most Americans. The law would allow enrollment of people whose incomes are up to 138 percent of the federal poverty level and, in a major change for Florida, allow enrollment of childless adults.
While the federal government would pay 100 percent of the expansion costs during the first three years, its share would gradually drop to 90 percent in 2020, with the state picking up the rest of the tab. Analysts last week estimated that the expansion would cost the state about $3.5 billion over a decade --- with the federal government paying about $51 billion.
Numerous details still need to emerge about the possible alternative plan that Negron presented to the Senate select committee Monday. But broadly, it would create a voucher-like program for people to buy private health insurance.
The plan would target the same people who would be newly eligible under the Medicaid expansion and also would rely on federal money to help subsidize coverage. But instead of enrolling people in Medicaid, it would build on an already-existing program, the Florida Healthy Kids Corp., to offer coverage through private insurers.
Florida Healthy Kids provides subsidized private health-insurance to about 240,000 children of low- and moderate-income families, as part of the federal Children's Health Insurance Program. Families pay $15 or $20 a month for coverage, with the state and federal governments subsidizing the rest of the costs.
Rich Robleto, executive director of Florida Health Kids, said the program's structure could be broadened to also include the type of expansion discussed by the Senate select committee.
"It's the kind of thing that we can do,'' Robleto said. "It's the kind of thing we have been doing for 20-something years."
Florida lawmakers in 2011 approved a major overhaul of the Medicaid program that eventually will lead to almost all beneficiaries enrolling in HMOs and other types of managed-care plans. But the possible Obamacare alternative would be separate from that effort.
Negron said he will ask Gaetz, the Senate president, to send the possible alternative to another committee to work out details. But among the big questions are whether the federal government would go along with the concept and whether it would approve such moves as requiring enrollees to be charged co-payments for medical services --- something Negron said he would like to see.
The Obama administration recently indicated it would allow Arkansas to funnel people into private coverage instead of Medicaid. But the Arkansas proposal, which has not been finalized, includes a crucial difference from the Senate idea: It would use health-insurance exchanges, which are part of the Affordable Care Act, to serve as the vehicle for people to sign up for private coverage.
Despite seeing Republicans vote down the Medicaid expansion, Senate Democrats issued a statement after Monday's meeting that appeared to indicate support for the possible alternative. That statement noted that the alternative would also address many of the goals of the Medicaid expansion.
"Although Republicans voted against what they called 'traditional Medicaid expansion' they turned around and endorsed a program that still relies on the same federal dollars and still extends affordable health care to 1 million Floridians," Senate Minority Leader Chris Smith, D-Fort Lauderdale, said. "Whatever name they opt to give the program, the bottom line is that money allocated by the federal government for Medicaid expansion will be the mechanism. In the Senate, the remaining question is no longer ‘if,’ but ‘who.’ "
But Senate Republicans, who have long complained about the costs and size of Medicaid, sought during the meeting to distance themselves from a potential expansion of the program.
"I think fixing health care is not expanding a broken system,'' said Senate Health Policy Chairman Aaron Bean, R-Fernandina Beach. "Medicaid … it's not good."