Florida lawmakers adjourned last Friday without adding a Medicaid expansion to the state budget, in spite of Gov. Rick Scott embracing that expansion just this February.
The Medicaid expansion would have been completely underwritten by the federal government.
“While the federal government is committed to paying 100 percent of the costs, I cannot deny Floridians who need access to health care,” Scott said to reporters at that press conference in February.
This lack of legislative action will leave 1.3 million Florida residents uninsured. It is not known whether a legislative special session will be called to address the issue.
Why have Florida legislators chosen to reject Medicaid expansion again this year, even with the $51 billion promised over the last decade from the federal government? The expansion would help the 750,000 low-income Florida residents who have found they were making too much money for Medicaid but not enough to afford insurance.
Consider the case of 32-year-old Charlene Dill of Orlando, Fla., who died last month because she was in that unfortunate situation. She made $9,000 a year. She could not afford insurance for her documented heart condition, and she was denied Medicaid because, even with three children to support, she made too much money.
“People like Charlene are dying,” said Monica Russo, state council president of the Service Employees International Union, at a press conference after Dill’s death. “The thing is, the resources are there to pay for it. That’s what’s so mind-boggling about this situation. The money is there; it’s on the table.”
Florida hospitals also are expected to feel the monetary impact of the legislative inaction.
And Florida is not alone, since 24 other states have also turned down Medicaid expansion.
The Affordable Care Act, known as Obamacare, was signed into law March 23, 2010. The mammoth legislation represented the culmination of an intense public battle centered on health care in this country.
Needless to say, the ACA was filled with countless hidden provisions and even lesser known ramifications. One of its key pillars was the disallowance of pre-existing conditions as restrictions to health-care insurance. This provision ensured that millions of Americans would have access to health-care insurance. Left unchecked, the removal of the pre-existing conditions clause would foreseeably result in the financial demise of the third-party payers.
The ACA counteracted this economic threat to the financial stability of the nation’s insurance industry by imposing a mandate of participation in insurance coverage to all Americans, even those who were at a low risk.
This “insurance mandate” served as the centerpiece and guarantor of the financial viability of the ACA, but it also inspired the greatest amount of ire from the electorate, which resulted in passionate displays of anger, countless scenes of citizens yelling at their seemingly obstinate congressmen and senators, and the birth of the Tea Party.
However, the passage of the ACA did not serve to quiet anxiety among the constituency. Instead, President Obama’s signature only signaled a change of venue. With the act’s ratification, the largely political and socioeconomic discussion became legal in nature. Within weeks of the ACA’s passage, questions as essential to our country’s fiber as the scope of the 10th Amendment and the relationship between the citizenry and the federal government materialized in the form of legal challenges to the legislation.
The cases quickly made their way through the various federal courts with answers from judges as varied as the opinions of the citizenry. It became apparent that a definitive answer was needed regarding the constitutionality of the insurance mandate, an answer that could only come from the nation’s highest court.
On Nov. 14, 2011, the Supreme Court decided to entertain the question regarding the constitutionality of the ACA’s individual mandate. The Court had to wrestle with a very specific legal question: Does Congress have the power to compel an individual to purchase a product, in this case health-care insurance, in order to address what it perceives as a monumental economic and societal problem? Phrased differently, does Congress have the authority to force an individual, who has opted to remain outside the stream of commerce, if only temporarily, to enter the stream at the time and manner of Congress’s choosing?
By January 2014, the ACA had enrolled three million people. In the end, eight million people signed up between the federal and state marketplaces in the first enrollment.
Another concern people had with the ACA was that young people would not sign up for insurance, causing premiums to skyrocket.
However, 28 percent of new enrollees are between the ages of 18 and 35 years old, dispelling that worry.
Because ACA plans seem to be working, statistics show that 59 percent of Americans want to keep the law in place, according to Health Care For Florida Now statistics.
Since Florida spoke out against the ACA, it was unlikely that Gov. Rick Scott would accept federal dollars to implement a federal exchange.
Surprisingly, Florida was resistant to establishing a state-based health insurance exchange, but has proved to embrace it.
More than 440,000 Florida residents enrolled, placing them just behind the California enrollment. Out of that number, 90 percent qualified for financial assistance.
U.S. Sen. Marco Rubio is partly responsible for this change of heart. In 2008, he advocated Florida Health Choices as a better alternative to the federal exchange.
Six years in the making, Florida Health Choices opened for business with an inventory of products that cannot legally be marketed using the words insurance, coverage, benefits or premiums, according to Rose Naff, chief executive officer.
Naff indicates that the Florida health insurance marketplace is “not trying to meet the requirements outlined by Obamacare and there is no plan to offer broader insurance plans, which would meet the Obamacare standard.”
Florida is one of the 15 states that run their own exchanges, while 36 states are enrolling in HealthCare.gov, the federal exchange.
Open enrollment for 2014 has ended, unless a Florida resident has a qualifying event that would make him a candidate for the special enrollment period. If a resident marries, gets a divorce, changes jobs or has a child he or she may qualify to still enroll. If a resident has already signed up and wants to change coverage, there may be a loophole so they can make a change in the special enrollment period.
Otherwise, for all other Florida residents, open enrollment for 2015 coverage begins Nov. 15, 2014.
A complete explanation of the Florida Health Insurance Marketplace is online at www.healthcareforflorida.org. The website is a joint project of Progress Florida and FL CHAIN, or Florida Community Health Action Information Network. Their goal is to educate Floridians about new health coverage opportunities.
