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Florida rejects Medicaid expansion, leaves 1 million uninsured


It seemed like a watershed moment for the Affordable Care Act when Florida Gov. Rick Scott (R), a staunch Obamacare opponent, embraced the Medicaid expansion in February.

“While the federal government is committed to paying 100 percent of the costs, I cannot deny Floridians who need access to health care," Scott told reporters at a press conference.

Scott wouldn't be the one to "deny Floridians" a part of the health care law—but the Florida legislature had other plans. Lawmakers adjourned Friday after passing a budget that does not include funding for a Medicaid expansion. Unless the Republican-controlled legislature comes back for a special session later this year—which some Democrats are calling for—Florida will not expand Medicaid in 2014.

In Florida, where one in five non-elderly residents lack insurance coverage, the consequences are especially large: An estimated 1.3 million Floridians were expected to gain coverage through the the Medicaid expansion. About a quarter of those people—Floridians earning between 100 and 133 percent of the Federal Poverty Line—would still be eligible for tax subsidies on the health insurance exchange.

Florida now joins 24 other states that have either decided against expanding Medicaid, or are leaning in that direction, according to analysts at Avalere Health. One caveat: They created this map just prior to the Florida legislature's adjournment and might now consider Florida in the "will not expand" category.

This isn't a phenomenon reserved to Florida. In Ohio, Gov. John Kasich (R) is having trouble moving the Medicaid expansion he supported through the state's Republican controlled-legislature. Similar fights are playing out in Arizona and Michigan, where Republican governors find themselves in the relatively odd position of trying to sell Obamacare to state legislators of their own party.

In a way, this is a bit surprising. No one ever expected to hear Scott extoll the benefits of President Obama's signature legislative accomplishment. That being said, the Medicaid expansion is a really big deal for state budgets—the budget that Scott is charged with overseeing. If his state had participated in the Medicaid expansion, the Urban Institute estimated it would bring $66 billion of federal funds into the state over the course of a decade.

That same burden doesn't rest so heavy on state legislators. States and hospitals tend to cover much of the country's uncompensated care and unpaid medical bills. Meanwhile, state legislators have faced intense pressure over this vote. In Ohio, my colleague Sandhya Somashekar reported on one group that went door-to-door collecting signatures from voters pledging to thwart reelection efforts should lawmakers there vote to expand Medicaid.

While there's an outside chance that Florida could pass a Medicaid expansion through a special session, at the moment it's not going anywhere—despite the governor's endorsement.

Correction: The headline on this post initially said 1.3 million Floridians would not gain health insurance under the Florida decision. About a quarter of those people would still have access to subsidized, private health insurance coverage under the health exchange.



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Brad Plumer · May 5, 2013

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