FORT LAUDERDALE, Fla. (AP) — Experts warned Florida lawmakers Monday that if they do not expand Medicaid, it will create a coverage gap for those who earn too little to qualify for tax credits to buy insurance from the online exchange but too much to qualify for Medicaid. The decision would also keep Florida from receiving billions of federal dollars to help pay for those health costs while heaping greater burdens on hospitals treating the uninsured.
Republican Gov. Rick Scott and GOP lawmakers have warned that Medicaid coverage to about 3 million of the state's poorest is consuming the state budget at roughly $21 billion a year and must be reined in. Scott is also worried that the cost of expanding Medicaid coverage to an estimated 900,000 more residents under the Affordable Care Act is too high for Florida taxpayers.
But several experts stressed that the residents who will become eligible for Medicaid under the federal health overhaul will be paid for by the federal government for at a much higher rate than those who are currently covered under a roughly 50 percent matching rate. The Obama administration will pick up 100 percent of cost for first three years if a state expands Medicaid and 90 percent after that.
Even if the state chooses not to expand Medicaid eligibility levels, the publicity will likely increase enrollment for those who are currently eligible. The state would have to contribute more than seven times more for an already eligible person than for a newly eligible person over a 10-year period, Greg Mellowe, Director of Health Research and Analysis, Florida Center for Fiscal and Economic Policy , noted at a committee hearing in Tallahassee.
It's unclear how many people might fall under that category. Conservatives warn that people will come out of the woodwork to apply for health coverage and that states will not be able to afford it.
Committee Chair Sen. Joe Negron noted that Arizona enrollment was more than twice what state officials estimated when the state expanded health coverage to childless adults and the state ended up dialing back the program.
Alker agreed there is a "pent up demand" from some uninsured patients with pre-existing conditions and other factors keeping them from getting insurance that will likely cause some type of uptick in enrollment.
But she said the feds will foot the entire bill for those enrollees initially under the expansion and enrollment will likely lessen in future years when states are paying a higher share.
Mellow also noted no federal health program, including Medicare, enrolls 100 percent of those who are eligible.
Experts said it's important for states to expand Medicaid so they can draw down on the additional federal dollars to offset the costs of those who may enroll under current reimbursement rates.
Georgetown University Health Policy Institute Research Associate Professor Joan Alker recommended the state dial down programs that cover mental health, substance abuse and other health safety nets, arguing that patients won't have to rely on them as much if they already have health insurance. She estimated that could save about $100 million a year. That money could then be spent helping to cover Medicaid expansion.
If the state does expand Medicaid coverage to an additional 900,000 residents, many receiving health coverage would be children who are already eligible for health coverage but are still not insured, Alker said. That's because the federal health law requires parents to enroll their children before they can get coverage.
"We're going to cut funding from these state programs so we can expand a different state program because the feds are going to pay for that for a little while...it seems to me that we're just shifting the same pockets. We're doing more than robbing Peter to pay Paul," said Republican Sen. Anitere Flores.
Several lawmakers also expressed concern that federal health officials will eventually reduce the amount they reimburse states.
Alker suggested Florida take a cue from Ohio, which recently opted to expand Medicaid with the caveat that if federal matching rate decreases, the state will drop out.
Experts also noted an expansion would also significantly impact Florida's tourism and hospitality industries.
"Almost a half million uninsured low-wage Florida workers would be newly eligible and almost all of them are employed in service sector jobs. We need Medicaid expansion to make those workers, many whom are parents, eligible for coverage," said Mellowe.
An expansion would also create about 54,000 new jobs and generate significant spending and reduce the amount of money spent covering uninsured patients to hospitals, insurers and taxpayers, said Mark O'Bryant, president and CEO of Tallahassee Memorial HealthCare.
Sarasota Memorial, a public hospital in southwest Florida treated 200,000 patients last year. About 60,000 of those patients were uninsured and under age 65, costing the hospitals more than $84 mil in 2012 for uncompensated care, said Gwen McKenzie, president and CEO of Sarasota Memorial Health Care System.
The hospital has about 100,000 emergency room visits a year. About half of them are from patients without insurance, she said.
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