Medicaid Expansion: Utah, Georgia See Movement; Report Blasts Florida Legislators

States that have not expanded Medicaid are seeing the fallout in hospital budgets and in local governments that must make up difference for those who fall in the coverage gap.

As President Obama winds down his final year in office, states that have yet to expand Medicaid to those earning up to 138% of the poverty line continue to weigh one of the more controversial elements of his signature healthcare law.

After many false starts, another bill that would cover 70,000 residents in Utah in the “coverage gap,” seems like it has a chance. Last summer, a proposal called UtahAccess+ failed to make it before the state’s House of Representatives. However, this new plan would pay the state’s share with a hospital assessment and a new tax on e-cigarettes.

In Georgia, there have been fewer concrete steps to expand the Affordable Care Act, but state legislators made statements this week suggesting things may change. State Senator Fran Millar, a Republican, told Georgia Public Broadcasting that expansion was likely at some point to improve access.

“I can show you a map that shows you, in certain counties, the only people in the medical field are marriage and family therapists. We have a real problem with the number of providers; we have a problem with nurses, throughout this entire state … We don’t have sufficient access in many portions of this state.”

Millar went on to say that states like Arkansas could provide a model for waivers that could pass muster with conservative lawmakers in Georgia who dislike anything associated with "Obamacare." He said he didn’t known when expansion would happen, but that he thought it was “inevitable.”

Then there’s Florida, where Governor Rick Scott had a showdown last year with CMS over extension of funding for the state’s Low-Income Pool, or LIP, a special agreement that sends federal funds to hospitals that serve a disproportionate share of uninsured patients. CMS didn’t fund LIP at prior levels and will cut funding for 2016-2017, which has advocates for Medicaid expansion looking ahead to what will happen to county governments when this shortfall hits.

A scathing report issued last week, commissioned by the League of Women Voters and prepared by Florida Legal Services, said that the legislature’s refusal to accept federal funding will be destabilizing for hospitals and county governments alike, in addition to leaving no humane solution for those in the coverage gap.

Florida has 1 million people who could gain coverage if the state accepted expansion funds, including 600,000 in the coverage gap, according to Miriam Harmatz, a senior health law attorney with Florida Legal Services and co-author of the report.

“We are in a state (that) hasn’t accepted the funding, so they have no path to affordable coverage,” she told media on a conference call last week.

The report’s authors say the refusal to accept Medicaid expansion, and the resulting cuts to the LIP under the terms CMS has imposed, will result in a $4.85 billion loss over 5 years, which will create an $8 billion loss to the state’s gross domestic production, job losses of 15,000 and $8.25 billion in lost income.

Florida lawmakers who have rejected Medicaid expansion say the state cannot afford it over the long haul. Scott initially made a statement supporting expansion but then backtracked.

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