Novel Way To Expand Medicaid Needs Congress’ Approval

Call it an end-run around state leaders who have stood in the way of easier access to medical care. After more than a decade of seeing Republicans block Medicaid expansion, congressional Democrats have hit upon an idea to use the budget reconciliation process to expand Medicaid by working directly with cities and counties.

It's an idea that is overdue. For more than a decade, Republicans have used specious arguments to stall a badly needed reform that would provide health coverage and access to medical services for more poor and disabled. It would allow Florida and other states to use more of their own tax money to meet pressing state needs.

"The issue here is that Florida has had ample opportunity to accept billions of dollars in federal funding and consistently our governor and legislature have refused that," said U.S. Rep. Ted Deutch, a Boca Raton Democrat and an architect of the initiative.

The idea is still in its early stages. While the money has already been appropriated, it will take new legislation or language in the budget-writing process to be the vehicle to funnel the Medicaid expansion money around the roadblocks in state capitals to the localities that want it. Given the ongoing needs of the uninsured and the impact of a resurging COVID-19 pandemic, turning this idea into reality should be a no-brainer.

An estimated 2.8 million Floridians lack health insurance, according to U.S. Census data. For them, it's simply easier and certainly more affordable to wait out a nagging pain or ailment before seeking healthcare at the local emergency room. Unfortunately, forgoing less-expensive preventative care adds up to more costly medical care that taxpayers pay local and state governments.

For years the Florida Legislature has wrestled with Medicaid expansion, as prescribed by the Affordable Care Act and as a free-market variant. In demonstrating contortions that would make Olympic gymnast Simone Biles proud, former Gov. Rick Scott initially opposed expansion, then shocked many by supporting the change before opposing it again.

Gov. Ron DeSantis isn't a fan either and has yet to comment on the idea of bypassing the statehouse to expand Medicaid in Florida.

Critics insist state governments will save money in the long run by blocking expansion efforts. But the numbers don't bear that out. Florida has passed up roughly $66 billion in federal funds since Medicaid expansion began nationwide in 2010 under the Affordable Care Act. There's also the fact that 1.5 million Floridians who still can't afford health insurance and lack access to medical care would directly benefit from the program change.

Both statistics amount to a harsh indictment on recalcitrant state leaders who have deprived their constituents of less-costly heath care options by playing politics with Medicare expansion. As the frustrations of meeting ever higher healthcare costs grow, so too does the need for an alternative that offers better healthcare and budget relief.

Under Medicaid expansion, the federal government initially pays the entire cost of expansion before dropping its share to 90%, leaving the state with the remaining10%. For Florida along with 11 other states, the state government share is 40% and the federal government pays roughly 60%.

At first, Republican leaders in politically red states derided the idea, arguing that their budgets couldn't handle the costs of a more expansive healthcare program. Many states sued, ultimately winning a decision from the U.S. Supreme Court in 2012 that ruled that states couldn't be forced to expand Medicaid services.

Republicans across the country hailed the ruling as a states-rights victory and a legal blow to the what they saw as "government-run healthcare." However, their opposition to Medicaid expansion began to fade as health care costs continued to rise and the benefits of expansion in other states became more obvious.

Thirty states, including politically ruby-red Louisiana, Missouri and Oklahoma, have adopted Medicaid expansion. Arizona, Arkansas and Utah are among the eight states that have decided to expand Medicaid using alternative plans through a federal waiver.

Our state should drop its inane opposition to Medicaid expansion. This, however, is Florida, where the concept has never had a chance in the Republican-controlled statehouse. It shouldn't take an act of Congress to make a program that helps the poor, disabled and the vulnerable get and stay healthy but given the obstinance of state leaders, this congressional initiative is warranted.

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