With a week left to try to reach a compromise, the House on Friday approved a plan to offer $2,000 subsidies to low-income Floridians as an alternative to expanding Medicaid under the federal Affordable Care Act.
The 71-45 vote was largely a foregone conclusion and came as the Senate prepares Monday to take up a far-different proposal to expand health coverage. It remains unclear whether the House and Senate will be able to agree on a compromise before the May 3 end of the legislative session.
"Our door is open,'' Senate President Don Gaetz, R-Niceville, said after the House vote. "Our minds are open."
The House bill (HB 7169) would reject tens of billions of dollars in federal Medicaid money and create a new state program, dubbed the "Florida Health Choices Plus" program. It would offer $2,000 subsidies to low-income working parents and some people with disabilities and take what backers say is a "free market" approach to making coverage available.
"Free market economics work,'' said Rep. John Wood, R-Winter Haven. "What we're trying to do in Florida is revolutionary."
But Democrats said the bill would not work, as the $2,000 subsidies --- along with required $300 contributions from enrollees --- would not be enough to pay for coverage. Rep. Jim Waldman, D-Coconut Creek, called the House proposal "fiscally irresponsible" and made a public plea to Gov. Rick Scott, who has supported the Senate approach.
"Take that pen of yours and if this bill comes before you, veto it,'' Waldman said.
The vote was along almost-straight party lines, with only Reps. Mike Fasano, R-New Port Richey, and John Tobia, R-Melbourne Beach, crossing over to vote against the bill. No Democrats supported it.
House and Senate Republicans have made clear they will not expand Medicaid eligibility as was originally contemplated in the Affordable Care Act, better known as Obamacare. But while they say they want to find another way to expand health coverage for low-income people, they remain far apart.
Perhaps the biggest difference is that the Senate wants to tap into federal money that otherwise would be available for the Medicaid expansion and use it to offer private health insurance. House Republicans have flatly refused to accept the Medicaid money and turned back a proposed amendment Thursday that would have gone along with the Senate plan.
Under the House proposal, the subsidies would be available to people whose household incomes are at or below 100 percent of the federal poverty level, or $19,530 for a family of three. People whose incomes are higher could seek subsidized coverage through a federal health-insurance exchange, a separate program that the state would not run.
The House bill would lead to low-income people getting coverage through a long-planned online health marketplace, the Florida Health Choices program. Republican leaders say the enrollees could use the subsidies to choose among various coverage options in the marketplace.
Bill sponsor Travis Cummings, R-Orange Park, said the plan would improve the state's safety net, while also "shifting the dialogue to quality health care, improved access and long-term innovative solutions."
Democrats, however, said the measure is a missed opportunity to draw down more than $50 billion in federal Medicaid money during the next decade and use it to provide coverage to roughly 1 million people.
"This (House) bill is wrapped in a beautiful box,'' said Rep. Mia Jones, D-Jacksonville. "The paper is beautiful. The bow is beautiful. But when you open that box up, the box is empty."
Rep. Victor Torres, D-Orlando, pointed to a large number of Hispanics who lack health insurance and said many go to hospital emergency rooms for care.
"This plan does not do anything for those working class Hispanics or other people in the state of Florida," Torres said.
Those comments drew a quick reply from Rep. Jose Oliva, R-Miami Lakes, who said the House plan would be preferable to expanding Medicaid, which he described as providing "second-class care."
"I'm a Hispanic, too, and I can't imagine why you would say this does nothing for Hispanics," Oliva said