To House Republicans, it's a plan to transform health care along the lines of Amazon.com. To Democrats, it's a missed opportunity, or in the words of one, a "dog and pony show."
But a GOP-dominated select committee Monday left little doubt that it is behind Speaker Will Weatherford in pursuing what is being touted as a free-market alternative to expanding Medicaid under the federal Affordable Care Act.
On a party-line vote, the select committee approved a bill that would offer $2,000 subsidies to targeted groups of uninsured low-income people, who would buy coverage through a long-discussed health marketplace. The plan would reject using more than $50 billion in federal funding that would otherwise flow to the state during the next decade for Medicaid expansion.
Also, the select committee rejected a Senate proposal that would use federal money to help low-income people buy private health insurance as an alternative to expanding Medicaid.
Select committee Chairman Richard Corcoran, R-Land O' Lakes, said House Republicans want to make dynamic changes to the health-care system that will allow people to get services they need and help reduce costs. Weatherford, R-Wesley Chapel, and Corcoran unveiled the plan last week.
"We're trying to build an Amazon.com of health care,'' Corcoran said.
Democrats, however, blasted the GOP for proposing a plan that would provide far less money and serve fewer people than the Medicaid expansion or the Senate private-insurance alternative. They also repeatedly said Florida residents have paid federal tax dollars that could flow to other states if lawmakers turn down the Medicaid money.
"We need to treat as many people as we can,'' said Rep. Dwight Dudley, D-St. Petersburg. "We have paid our taxes. It's our damn money."
The select committee, which has been studying the Affordable Care Act for months, voted 11-6 to approve the bill (PCB SPPACA 13-03), after voting by the same margin to reject the Senate proposal. One of the House bill's key architects, Orange Park Republican Travis Cummings, said the bill could go to the House Appropriations Committee on Friday.
The bill would target people whose incomes are at or below 100 percent of the federal poverty and have children or who are disabled and eligible for the federal Supplemental Security Income program. It would offer $2,000 annual subsidies for them to buy insurance and other health services through the Florida Health Choices program --- an online health-care marketplace that lawmakers created in 2008 but has not started operating.
Eventually, the plan is estimated to serve about 116,000 people, at a cost to the state of nearly $239 million a year, according to a House staff analysis. Participants also would have to chip in $25 a month and could use the subsidies, for example, to buy high-deductible insurance coverage. The plan is dubbed the "Florida Health Choices Plus Program."
Medicaid expansion under the Affordable Care Act or the Senate private-insurance alternative would offer coverage to roughly 1 million uninsured people whose income is up to 138 percent of the federal poverty level. Both would include offering coverage to childless adults, a group that is now largely shut out of Florida's Medicaid program and also would not be part of the House subsidies.
House leaders, however, say their plan takes into account people between 100 percent and 138 percent of the poverty level, because those people would be able to get subsidized coverage through a separate federal health-insurance exchange. As measuring sticks, a family of three with an income of $19,530 would be at 100 percent of the poverty level, while a family of three with an income of $26,951 would be at 138 percent of the poverty level.
Democrats raised repeated questions Monday about details of the House plan, such as questioning how extremely low-income people could afford high deductibles that would go along with the health coverage. At one point, Rep. Elaine Schwartz, D-Hollywood, said it was unfortunate this "dog and pony show is taking place."
But Republicans said they did not want to depend on the deficit-laden federal government to pay for the Medicaid expansion in the future. Also, some GOP lawmakers reiterated their longstanding criticism of Medicaid's growing costs.
"This program is totally, absolutely unsustainable,'' said Rep. John Wood, R-Winter Haven.
With the annual legislative session scheduled to end May 3, it remains unclear how --- or if --- the House, Senate and Gov. Rick Scott will be able to reach agreement on a health plan. The Senate Health and Human Services Appropriations Subcommittee is scheduled Wednesday to take up the bill (SB 1816) that would use federal money to offer private insurance and another bill (SB 1844) that is somewhat similar to the House plan.
But backers of Medicaid expansion tried to increase pressure on lawmakers Monday, holding a news conference and then going to Weatherford's office to seek a meeting with him. The speaker met briefly with members of the group.
"This is the 100 percent speaking, not just the tea party,'' said Wilson Barnes, 72, a Tallahassee resident who served as a spokesman for the group.