Sifting through the opposing rulings on the legality of the subsidies on the federal health insurance exchange.
July 03--If Gov. Scott and his Republican colleagues in the Legislature continue to be sore losers over the Supreme Court's ruling on the Affordable Care Act, Floridians will be the ones who suffer.
The governor, who promised to implement the law once the Supreme Court ruled, is now saying Florida will do the minimum to comply and will not expand its Medicaid program or establish health care exchanges. So much for his love of the Constititution.
"We're not going to implement Obamacare in Florida. We're not going to expand Medicaid," Gov. Scott told Fox News host Greta Van Susteren. "We're not going to do the exchange. Because what this does is raise the cost of health care for all Floridians. It just doesn't work."
How would the governor know it doesn't work since Florida has yet to implement the law? It's working for the 224,000 young Floridians who have been able to stay on their parents' insurance plans, the 256,600 Florida seniors on Medicare who pay less for their prescription drugs and the 6,000 Floridians with pre-existing conditions the law has enabled to get health coverage.
Florida was the lead plaintiff in the lawsuit against health reform, arguing that the individual mandate that required nearly every American to buy health insurance was unconstitutional and a provision requiring states to expand Medicaid was unlawful coercion.
The justices upheld the mandate -- and by extension the entire law -- by ruling Congress can require the purchase of insurance under its taxing power. The Obama administration had argued it was legal under the Constitution's commerce clause.
In a surprising move, the justices gave Florida and the 25 other states that sued a partial victory by agreeing with them on the Medicaid provision, calling it "economic dragooning." The ruling essentially allows states to opt out of expanding their Medicaid programs. That provision covers more than half of the 32 million people expected to become insured under the law.
Florida spends $21.4 billion on Medicaid, of which the state share is $9.7 billion. The federal government pays the balance. The expansion of Medicaid would allow people earning up to 133 percent of the poverty level -- $30,657 for a family of four -- to become eligible. Gov. Scott said that would cost Florida$1.9 billion a year. "We can't," he said, "pay for that." The federal government would cover the full costs in the first three years and the most the state ever would pay is 10 percernt of new costs.
Gov. Scott's figure is significantly higher than estimates by the Florida Agency for Health Care Administration, which administers Medicaid. Independent researchers say even ACHA's figures are based on unrealistic assumptions, such as that 100 percent of those eligible will enroll. That has never happened in any state for either Medicaid or Medicare. ACHA's estimates also don't include savings that the health care law will generate for the state.
Researchers for the Jesse Ball DuPont Fund estimate that Florda's worst-case scenario would be $1 billion in new state spending. The best case would be no new spending and the possibility of as much as $3 billion in savings over six years.
States that choose not to expand Medicaid will be turning down millions in federal dollars and, more importantly, will be denying access to health care for millions of their residents. By expanding its Medicaid program, Florida would extend coverage to more than 1 million of its 4 million uninsured.
Gov. Scott hopes to gain politically by thumbing his nose at the law. But by complying with the law, Florida gains a healthier citizenry.
for The Post Editorial Board
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