- Democrats in Congress are set to begin voting this weekend on an inflation deal.
- But the agreement does not expand health care coverage for people with incomes close to the poverty level.
- Approximately 800,000 Floridians will remain uninsured and the next opportunity for coverage may not be until 2024.
When Democrats in Congress announced last year that they were working on a massive spending bill to transform America’s social safety net, health care advocates in Florida were optimistic that there might finally be a way. to provide medical coverage to more people.
Last week, however, his hopes were dashed. One of the many elements that made it to the courtroom in the Democrats’ compromise of the $740 billion Inflation Reduction Act was a provision to bypass Republican state lawmakers to expand Medicaid to nearly 800,000 Floridians.
The omission is a huge blow to Florida’s uninsured, particularly at a time when many are worried about a recession, and residents are already facing high costs at the grocery store and at the gas pump, as well as skyrocketing rent billssay health advocates.
“It’s definitely a missed opportunity, especially if everything is focused on inflation and the impacts of inflation,” Scott Darius, executive director of nonprofit advocacy group Florida Voices for Health, told Insider.
Florida is among 12 Republican-led states who refuse to expand Medicaid under the Affordable Care Act, commonly known as Obamacare. Under the law, states pay 10% of the costs, while the federal government picks up 90% of the bill.
Florida isn’t likely to get a chance to expand Medicaid until 2024 at the earliest. Florida health care advocates and Democrats have little faith that Republicans in the state legislature will change their position against expanding Medicaid, so they hope to put the question on a ballot in the 2024 election so that voters participate directly.
“The ballot measure is our best shot at getting Medicaid expansion passed,” state Sen. Shevrin Jones, a Miami Gardens Democrat who sits on the state Senate health policy committee, told Insider.
“This should be the top priority for us, but Republicans have shown us time and time again that they are not interested in what makes sense,” Jones added. “They are interested in what feeds their base.”
In 2021, President Joe Biden’s $1.9 trillion coronavirus rescue package attempted to sweeten the Medicaid deal by defraying state costs for two years, but Florida still hasn’t agreed. Republican Gov. Ron. desantis office told the Washington Post in March 2021 that he “continues to oppose the expansion of Medicaid in Florida.”
The governor’s office and several other Republican leaders in the state legislature did not respond to Insider questions about whether any circumstances, such as a recession, might alter their stance on expanding Medicaid.
Republicans have raised concerns about shouldering more health care costs, citing fears the federal government may one day recoup Medicaid payments.
House Speaker Chris Sprowls, a Palm Harbor Republican, said he believes Medicaid should target only the most vulnerable residents, rather than be based on income, he told the orlando sentinel in March 2021.
Under Obamacare, people who earn $13,590 or less for an individual or $27,750 for a family of four are eligible to enroll in Medicaid. This draws objections from Republicans since it does not take into account disability or employment status.
The Rev. Vanessa Tinsley, executive director of Bridge to Hope, a Miami-based community organization whose services include a food program, said the narrative about people on Medicaid was not true. Many of the clients he serves have jobs and college degrees.
“It’s not about hard work, we have that here, but they work very hard at low-paying jobs,” he said, adding that while Florida raised the minimum wage, it hasn’t kept up with sky-high rents. A big medical problem can wipe out savings or raises, he said.
The US House version of the Biden agenda more than halved the price
For more than a year, Democrats in Congress have explored ways to bypass Republican lawmakers in states that resist receiving Medicaid. An estimated 4 million people nationwide who are uninsured could join Medicaid if all states expanded the program, according to a federal government report compiled by the Department of Health and Human Services.
The US House of Representatives’ $2 trillion Build Back Better Act, passed in November 2021, provided a solution to fill the Medicaid void. It would have paid the full cost of private health insurance premiums for people with near-poverty income.
But the provision was one of many removed to create the Reduce Inflation Act, although the bill retained other health care policies on drug prices and private health insurance for people with higher incomes who would not qualify for Medicaid.
The bill could still change. Democratic Senator Raphael Warnock of Georgia plans introduce an amendment to help people who cannot access Medicaid. He will introduce the amendment during “vote-a-branch,” a marathon session of amendment votes that could end up changing the final draft of the legislation. The Senate is considering the inflation deal starting Saturday.
Florida Voices for Health is working with Southerners to expand Medicaid to Push Congress this week to support the Warnock amendment.
But conservative Democratic Sens. Joe Manchin of West Virginia and Kyrsten Sinema of Arizona have been cautious about raising the price of the legislation. An estimate from the nonpartisan Congressional Budget Office found the Medicaid idea of the Build Back Better Act could cost the federal government $125 billion.
‘Maybe we have to get creative’
Without a federal solution or an immediate vote, the fate of Medicaid rests in the hands of state legislators or voters.
Bridge to Hope’s Tinsley said she was “terrified” of a recession as she already sees people living on the brink. She knows families whose parents can’t get married because their children wouldn’t otherwise qualify for Medicaid, people who skip needed medications, or parents with asthma who can’t afford health insurance and must borrow their children’s inhalers.
“The people in my food line used to be donors and volunteers,” Tinsley said. “Our resources are shrinking.”
Not being able to pay for health care makes people’s circumstances worse, he said. And many Floridians who have to cut back can only do so by cutting their grocery bills, she added. Less expensive foods are also often less healthy, leading to problems like diabetes and high blood pressure, which, in turn, increase people’s health care bills.
DeSantis is up for re-election in Florida and is expected to win as Florida Republicans have outnumbered Democrats in the state by 220,000 people. The two Democrats running for the nomination in the Aug. 23 primary to face him, Rep. Charlie Crist and Florida Agriculture Commissioner Nikki Fried, support expanding Medicaid.
Jones faces an opponent in the primary on August 23. If he is reelected, he plans to introduce a bill to expand Medicaid, he said. However, he said this round wants to see if there is a way to reach a bipartisan agreement as other GOP-led states have done, particularly after hospitals and health insurers rallied behind the effort.
“Maybe we have to get creative,” he said.