Florida hospital executives warned they will be hit hard if the state does not expand Medicaid coverage under the federal health overhaul because hospitals will lose federal funding they've been relying on to care for uninsured patients. Florida hospitals spent more than $2.8 billion caring for uninsured patients in 2011, hospital officials said Monday.
The Affordable Care Act will end some major federal funding streams to hospitals that cover large numbers of uninsured patients because the law assumes those patients will have insurance through Medicaid expansion or through state online health exchanges. But the U.S. Supreme Court ruled that Medicaid expansion is optional for states, leaving Florida hospitals concerned they will be on the hook for huge bills with less money to pay for them than in the past.
"If Florida doesn't expand Medicaid, we're going to have the money taken out of one pocket, we just won't get it put back in the other," Tommy Inzina, chief administrative officer at BayCare Health System, said at a House meeting in Tallahassee on Monday.
The majority of the new enrollees would be childless adults. The federal government would pick up 100 percent of the cost of adding previously ineligible individuals for the first three years and 90 percent afterward. That's much more generous than the roughly 50 percent matching rate that federal health officials currently pay for Medicaid. State economists estimate about 80 percent of those eligible for coverage would apply, not the 100 percent that some lawmakers have warned.
Florida's state health agency estimated that it will cost the state $3 billion over the next decade to fund Medicaid expansion.
Florida would receive about $26 billion from the feds to pay for Medicaid expansion over the next decade, hospital officials said.
"That's just too much money on the table...for Floridians to pass up, said Mark Robitaille, incoming president of the Florida Hospital Association.
If Florida does expand Medicaid and the feds do decrease their funding further down the road, then the state could reconsider at that point, said Mitch Feldman, CEO of West Boca Medical Center. But lawmakers have expressed concern that it could be difficult to stop a program once it's started.
Even if Florida expanded Medicaid, hospital executives said the amount of money hospitals will spend to finance the expansion and state health exchanges will be more than they expect to get back from both programs.
Inzina said it's possible reimbursement rates under the exchanges may be closer to Medicare and Medicaid reimbursement rates than commercial insurance.
"One of the most difficult variables in this is that none of us know what the exchanges are really going to look like, we don't know what they're going to pay and we don't' know what the premiums are going to look like," he said.
Republican Rep. Matt Hudson asked where those costs would be recouped.
Hospital officials said it's typically passed on to commercial insurers through higher premiums.
Hudson also expressed concern that there won't be enough doctors participating in the Medicaid program to meet the demand if the program expands.