FORT LAUDERDALE, Fla. (AP) — Health advocates and hospital executives warned Florida lawmakers on 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 residents 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 coverage for residents who will become eligible for Medicaid under the federal health overhaul will be paid for by the federal government at a much higher rate than that for 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.
The committee chairman, 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.
Cost estimates and enrollment will be much higher than health advocates project, said Tarren Bragdon, president and CEO of the Foundation for Government Accountability.
"Plan to throw people off Medicaid within a few years," he warned.
But several other experts noted that 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.