Could Florida Be Up Next in the Medicaid Expansion Queue?

Florida's Republican Governor, Rick Scott, tried and failed to expand Medicaid in 2013. Now, a coalition of hospital, business, and community leaders are advocating for private option-style expansion. CMS will have to decide how far it is willing to bend before President Obama leaves office.

There’s no question that Republicans won big and the Obama Administration took a beating during the midterm elections November 4, 2014. But since then, the news on Medicaid expansion, a key piece of the Affordable Care Act (ACA), is looking like a tale of losing the battle and winning the war.

One by one, Republican states that had refused to expand Medicaid to the working poor—those earning between 100% and 138% of the federal poverty line—are starting to come forward with a change of heart. Indiana has been looking at a plan for a while. Utah is in play. Tennessee unveiled its plan a week ago; Alabama’s governor did a 180-degree turn after insisting during his re-election campaign he wanted no part expansion.

But the big prize could be Florida, where Republican-turned Democrat Charlie Crist lost to incumbent Republican Governor Rick Scott, whose unsuccessful expansion effort failed to win support in the GOP-controlled Florida House of Representatives 2 years ago. Crist made it clear he supported expansion, and his loss seemed at first to put it out of reach.

Now, as has happened elsewhere, expansion is being backed by a coalition of advocates for the poor, Chambers of Commerce, and hospital leaders who need the revenue.

Called “A Healthy Florida Works,” the group is making another pass as the Florida House, this time armed with arguments that Florida-style expansion could be tailored to conservative tastes, based on the private option concepts used in states like Arkansas. Under their proposal, Florida’s Medically Needed program would be eliminated, and a state exchange would be created. (This is key, given the challenge before the US Supreme Court that would eliminate subsidies in states that do not run their own exchanges.)

In the past week, a series of news stories and editorials have appeared in Florida newspapers in support of expansion:

  • The Tampa Bay Times’ editorial, “A glimmer of hope on Medicaid expansion,” appeared Friday, took note of the increasing roster of states, including those run by Republicans, that have expanded Medicaid to the working poor. “There is absolutely no reason why Florida should not join them.”
  • Treasure Coast Newspapers of Stuart, Florida, pointed out the hypocrisy of arguments against spending more federal dollars on Medicaid, given the flood of federal spending on less-worthy programs in the state: food stamps, highways, artificial reefs, law enforcement, agriculture, Social Security. “Where of the opposition in Tallahassee to federal funds for these and hundreds of other projects?”
  • In the Tallahassee Democrat, former Republican state legislator and columnist Paula Dockery wrote, “We could call it the We Made Our Point plan, or the Capitalism over Socialism plan, or even the We Won and Obama Lost plan. It really doesn’t matter. Call it what you want. It’s still Medicaid expansion; it’s still part of the Affordable Care Act, and it’s still the right thing to do.”

Notably, the Florida proposal purports to include work requirements for newly eligible recipients, something that outgoing Pennsylvania Governor Tom Corbett tried and failed to get from CMS in his waiver. Alabama Governor Robert Bentley mentioned a desire for work requirements in announcing his interest in exploring expansion last week, too.

It is unclear if these Southern states are simply overlooking Pennsylvania’s experience, or if leaders believe that a chastened Obama Administration would be willing to revisit the work requirement. A key question is how far CMS is willing to go to embed Medicaid expansion, and more broadly, the ACA itself, as permanent fixture nationally before the president leaves office. If more states opt for Medicaid expansion and the ranks of recipients grow, the possibility of a future Republican president rolling back Obama’s signature legislation becomes increasingly remote.

Around the Web

A Healthy Florida Works

Dockery: Call it what you want, it’s still Medicaid expansion

Editorial: Medicaid expansion should be at the top of the agenda for 2015 Florida legislature

A glimmer of hope in Medicaid expansion