After rejecting the Affordable Care Act's Medicaid expansion, Florida Republican lawmakers have proposed what they call a market-based program for covering the uninsured that's entirely state-funded, prompting criticism from Democrats, progressive advocates and even the Republican governor, Rick Scott.
Partly modeled after the Healthy Indiana program, the "Florida Health Choices Plus" program would provide Floridians not currently eligible for Medicaid (and likely earning too little to qualify for support in the federal insurance exchange),with $2,000 annually to buy insurance or pay for healthcare out-of-pocket. The individuals would also contribute $25 a month, with eligibility contingent upon certain work requirements.
The plan, sponsored by Florida House Speaker Will Weatherford, would cover about 115,000 uninsured Floridians -- a fraction of the state's estimated 3.7 million uninsured and far fewer than the 816,000 who would be covered under ACA-expanded eligibility.
Part of Weatherford and other GOP members' argument for the plan is that Florida's uninsured aren't necessarily in such dire economic straits. Only 25 percent of Florida's uninsured live below the poverty line and almost half end up regaining coverage within four months, Weatherford wrote in a white paper outlining his proposal. And only 12 percent of the state's uninsured use more $2,000 in healthcare services a year, Weatherford said -- although it's an open question whether that's despite of or because of their lack of coverage.
"The Florida House has developed a plan that will fit the needs of Florida, not the requirements of Washington," Weatherford, a 33-year-old former real estate broker from a suburb of Tampa, said in a media statement.
Floridians who would be covered under the program would be able to buy insurance through the pre-ACA small business insurance exchange Florida Health Choices, which would sell a broad range of insurance products, including high-deductible plans. Employers could also used the account-based system to make defined contributions to their workers -- who, in retail and service industries in Florida and elsewhere, face an uncertain future of health coverage as businesses figure out whether to "pay or play."
Florida currently spends about $20 billion a year on Medicaid, and expanding eligibility is estimated to cost the state anywhere between $3.5 billion and $17 billion over 10 years, after the federal government's share drops to 90 percent. Weatherford's plan would cost the state an estimated $237 million annually.
Governor Scott, who did an about-face earlier this year in calling for Medicaid expansion, said Weatherford's plan "will cost Florida taxpayers on top of what they are already taxed under the President's new healthcare law" and "would be a double-hit to state taxpayers."
A bill under consideration in the Florida Senate would expand Medicaid mostly along the lines of the ACA and, Scott argued in a statement, "protects both state taxpayers and the uninsured in our state."
Florida Democrats, who hold a minority of seats in both the House and Senate, are making similar arguments in favor Medicaid expansion, and also saying it would benefit low-income workers. And on Monday, a group of activists led by retired Florida Supreme Court marshall and Vietnam War veteran Wilson Barnes staged a short-lived demonstration in Weatherford's office, calling for expanded Medicaid coverage, which led to having a closed-door meeting with him.