You really should be paying attention to the ongoing battle over the Medicaid expansion in Florida. If supporters of Obamacare get their way, it could help weaken the blockade of opposition that conservatives have successfully used to stall the expansion in multiple states this year, after it seemed to be progressing last year.
Now there’s been a new development in the Florida battle: The Obama administration appears to be playing hardball with Florida governor Rick Scott, who opposes expanding Medicaid, sending him a new letter increasing the budgetary pressure on him to take the Medicaid expansion money.
To catch you up, Florida had been in talks with the administration over expanding Medicaid to 800,000 or more Floridians. But Scott recently reversed his previous support for the expansion. Scott did this because the federal government is close to nixing some of the billions in Medicaid funding for another program — the Low-Income Pool, or LIP — which funnels money to hospitals for low-income patients. Scott says this shows the feds can’t be trusted to honor their commitment under the Medicaid expansion.
But some Florida Republicans are demanding Scott agree to implement the state’s own version of the Medicaid expansion, arguing that without that money — or the LIP money — the state’s budget is in trouble, imperiling tax cuts, a major GOP priority. And the Florida budget battle continues to drag on: The Scott administration is holding out for the LIP money, but won’t accept the Medicaid expansion money; state Senate Republicans want him to accept the expansion cash.
Now the Obama administration has sent a letter to the Scott administration, saying, in essence, that its position isn’t changing: The best way to cover poor Floridians is through the Medicaid expansion, and the administration may phase out the LIP money. “Coverage rather than uncompensated care pools is the best way to secure funding for low-income individuals,” reads the letter, which reiterates all the fiscal arguments in favor of the expansion. The obvious suggestion is that the LIP money may not materialize, and accepting the expansion money is the best way to cover poor people and resolve the state’s broader budget battle.
The Scott administration fired back today, accusing the administration of trying to coerce the state into accepting the Medicaid expansion by linking it to the possibility of losing the LIP money. But the administration maintains that the LIP program was always intended to be time-limited, and its letter lists a number of long-running substantive objections it has had to the program.
Beyond this dispute, the odd thing about the standoff is that both of the programs are funded by federal money. The Scott administration wants federal money to pay for health care for low-income people if it is through the LIP program, but not if it is through Obamacare.
It’s possible that one reason for the continued resistance is that conservatives see this as a hugely symbolic battle. The Koch-funded Americans for Prosperity is hammering Florida Republicans over the issue, blasting away at “Obama’s Medicaid expansion.”
It’s still unclear how this battle will end. One Florida paper says the Medicaid expansion’s odds are “dimming.” But if somehow Florida does accept the Medicaid expansion, that could mean nearly one million more people covered under Obamacare. Conservative legislators in a number of other states have stalled the expansion; perhaps if Florida accepts it, the fiscal logic of the expansion will appear more persuasive elsewhere.
Recent Gallup numbers showed that, even as the percentage of uninsured continues to drop due to Obamacare, GOP resistance to the Medicaid expansion in a number of states has had a substantial impact in the other direction, causing a significant drop-off in people gaining insurance from Medicaid compared to last year. So a lot is at stake here, both for the long term success of Obamacare, and for millions of people who could still gain access to health coverage if the administration can somehow get the expansion moving forward again.