TALLAHASSEE — Expanding Medicaid to cover thousands of uninsured Floridians has mostly been ignored by Republicans during this year’s legislative session, but U.S. Sen. Bill Nelson, a Democrat, is making a last-ditch effort to get it done.
Medicaid is a joint state-federal program, though most of the expansion called for under the Affordable Care Act would be funded by Washington. Florida Republicans have balked, arguing that in the future, the burden on state funds would become too great.
Politics might be an even bigger problem than money because Medicaid expansion is key to the success of President Barack Obama’s signature health law.
For months, Nelson has sought a way around the opposition while still meeting federal requirements. He thinks he has found it in a never-tried-before plan: Using healthcare money raised by counties to get the $3.5 billion needed to draw down $51 billion in federal funding.
“If you really want to get it done, and if your reason for opposing it really was that you didn’t want to commit state tax dollars in the out years to expanding Medicaid, then this is the opportunity to do that,” Nelson said Wednesday.
His plan would require the 32 counties that boost their hospitals’ Medicaid funding with local money to instead use those funds to draw down the federal funds. All 67 Florida counties would benefit, even if they did not contribute.
“Whatever is done has to be done on a statewide basis” to meet federal requirements, said Tony Carvalho, president of the Safety Net Hospital Alliance of Florida.
Nelson said hospitals and county officials have indicated to him that they are willing to shoulder the burden so people who lack primary care are not forced to seek help at emergency rooms.
“It’s like taking the local tax dollars out of one pot and putting it in to another pot, and it’s the same tax dollars,” Nelson said. “That’s why they’re willing to do it.”
Still, safety-net hospitals have to protect themselves, said Edwin L. O’Dell of Jackson Health System in Miami. While Miami-Dade’s largest public hospital system ended the last fiscal year with a $45 million surplus, it was near bankruptcy not long ago.
“We are going through a transformation,” O’Dell said. “We still have a lot of work to do.”
But even if counties put up the money, the federal government probably would still require Tallahassee to approve and administer the program.
A spokeswoman for Florida Senate President Don Gaetz said Nelson’s plan is not the answer.
“Utilizing local dollars to fund the state portion of an expansion of traditional Medicaid does not address President Gaetz’s concern with the federal government’s ability to finance Medicaid expansion in the long term or his belief that traditional Medicaid is a broken program that providers, patients and taxpayers are unhappy with,” spokeswoman Katie Betta said.