Cerabino: The cost of being stingy with Medicaid in Florida isn't only measured in dollars

Palm Beach Post (FL)

We're starting to get the death toll resulting from the games Florida played with the federal government over Medicaid.

A 2012 U.S. Supreme Court ruling that validated the Patient Protection and Affordable Care Act, also known as Obamacare, allowed some flexibility on one provision of the law.

That provision was an expansion of Medicaid, the federal/state health care program for the poor. Under Obamacare, Medicaid had expanded to cover more people -- more than 800,000 in Florida alone.

The health care law expanded Medicaid coverage to people who earn up to 138 percent of the poverty level, with the federal government bearing 100 percent of the additional costs for three years, and then gradually reducing that to 90 percent.

But the high-court ruling found that because the states would eventually share a small burden of the additional costs, the decision to expand Medicaid coverage would be contingent on each state's approval.

Florida's governor at the time, Rick Scott, had been an outspoken critic of Obamacare, so it was expected that he would join the Republican governors in 13 other states in rejecting the Medicaid expansion in their states.

But Scott did something surprising. He talked about the recent death of his mother, and her struggle to raise five children in poverty without reliable health care.

"Quality health care services must be accessible and affordable for all, not just those in certain ZIP codes or tax brackets," Scott said at a 2013 news conference.

"No mother, or father, should despair over whether or not they can afford -- or access -- the health care their child needs," Scott continued. "While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care."

Scott's decision was blasted by members of his own party and conservative groups.

Then-Florida House Speaker Will Weatherford said he was "skeptical that this inflexible law will improve the quality of health care in our state."

Slade O'Brien, the state director of the Koch-founded Americans for Prosperity, called the Medicaid expansion bad policy.

"For far too long, states have fallen for the promises of 'free' federal money, ignoring the insidious federal strings and the long-term effects on state budgets," he said.

But, as it turned out, this was mostly theater, because Scott's "good conscience" had a short shelf life.

And an ulterior motive: At the time Scott suddenly discovered his heart, he was negotiating with the Obama administration for a waiver that would allow Florida to move its existing Medicaid program through private insurers.

Scott's softening on Medicaid expansion made Florida temporarily fed-friendly, and helped grease the way for Florida to get that waiver. Once the waiver was in place for the private insurers, Scott reverted to rejecting the Medicaid expansion and joined a lawsuit to cripple key provisions of the national health care law.

"He engaged in a deceitful plan to privatize Medicaid, all while pretending to embrace an expansion of the program that would help his constituents," was how U.S. Congresswoman Debbi Wasserman Schultz put it.

Scott said he only planned to accept the expansion while the federal government paid for 100 percent of the expansion.

But the state's contribution to the Medicaid expansion would not be beyond 10 percent, which was a real bargain, and far less than the 40 percent share of costs the state paid for the rest of the program.

Dollars aside, what about the human cost, the cost that Scott briefly addressed when he was temporarily concerned about people in certain ZIP codes not having health insurance?

We have some numbers now on that human cost.

Researchers have been looking at the mortality rates of states that did or did not accept the Medicaid expansion. And a research report by the Center on Budget and Policy Priorities released in November quantifies the life-and-death outcomes of those decisions.

"Research shows that Medicaid expansion increased the share of low-income adults using medications to control chronic conditions like heart disease and diabetes," the report says. "The new study finds particularly clear evidence of a drop in mortality from conditions like these, which are amenable to medication and other treatment."

The study looked at the death rates of 55- to 64-year-olds likely eligible for Medicaid in states that expanded coverage to mortality rates in states that didn't expand coverage.

The study found that in 2014, the first year of expansion, the mortality rates fell by 9 deaths per 10,000 people, while in non-expansion states mortality rates rose by 21 deaths per 10,000 people.

Over a four-year period, the expansion of Medicaid saved 19,200 lives of Americans between the ages of 55 and 64, the study found, while the failure to expand led to the premature deaths of 15,600 Americans.

The most (2,920) were in Texas, but second on the list of premature deaths due to a failure to expand Medicaid was Florida, with 2,776 premature deaths.

It stands to reason that when people don't have access to health care, they sometimes die preventable early deaths.

Scott seemed to know that, in 2013, at least he could verbalize it.

In March, President Donald Trump announced that now-U.S. Sen. Rick Scott and two other Republican senators would be helping him come up with a "phenomenal" health care law.

"They're going to come up with something really spectacular," Trump said at the time.

But there was no plan, and Scott quickly distanced himself from being part of it.

"What I'm focused on is the cost side," Scott said.

The cost side? I guess he just means dollars.

But as for the human cost side, we have a number now. It's the premature deaths of 2,776 Floridians. And counting.

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@FranklyFlorida

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