The administration of Gov. Rick Scott is now contending that the federal health care overhaul will cost state taxpayers billions more than estimates from just a few months ago.
Scott's health care agency has drawn up dramatic new estimates that now prices the cost of implementing the overhaul - including expanding the state's safety net health care program to thousands of Floridians currently ineligible - at nearly $26 billion over a 10 year period.
That's three times higher than the nearly $8 billion figure drawn up by state economists back in August - and has immediately come under suspicion by health care advocates.
State economists have not yet endorsed the new numbers from the Agency for Health Care Administration nor has the Florida Legislature. But the new numbers are sure to influence the ongoing debate about whether Florida will reject federal dollars intended to help the state expand its Medicaid program.
Scott was a fierce critic of the health care overhaul, but then softened his opposition after the November election of President Barack Obama. Scott has asked to talk with federal officials and will meet Jan. 7 with Secretary Kathleen Sebelius of the U.S. Department of Health and Human Services.
"He continues to be concerned about how we can address cost, quality and access in health care," said Melissa Sellers, a spokeswoman for Scott. "This report shows that a major expansion of the state's Medicaid system would result in major costs for Florida families."
Greg Mellowe, policy director for the health care advocacy group Florida CHAIN, blasted the new numbers as fantasy that rely on indefensible and unreasonable assumptions. He pointed out the state assumes that everyone who would be eligible would sign up quickly for health care coverage from the state.
"These estimates are hyper-inflated and unreasonable to the point of having no real use whatsoever for planning purposes," Mellowe said in an email. "They are purely intended to evoke a visceral reaction and not to assist the budgeting process."
Medicaid is a $21 billion safety net program for the poor in Florida and currently the federal government picks up about 58 percent of the cost.
Obama's health care law called for states in 2014 to expand eligibility of Medicaid to those making up to 133 percent of the poverty level, or $29,326 for a family of four in Florida. The changes would also require adding people who are below the poverty level but not eligible for Medicaid such as childless adults.
The U.S. Supreme Court ruled this summer, however, that expansion of Medicaid is not mandatory and that states can opt out if they choose.
Most of the Medicaid expansion and other costs are being paid by the federal government. But the state has been trying to gauge the full financial impact to state taxpayers of both expanding Medicaid as well as paying higher reimbursement rates to health care providers.
Back in the summer, economists came in with much lower figures, saying it was hard to quantify some of the costs or even figure out how many people would enroll in Medicaid due to changes.
Now AHCA officials have revamped the estimates in several ways, including adding administrative costs as well as other costs they say will go up as a result of the Affordable Care Act.
Phil Williams, the assistant deputy secretary for Medicaid finance, refused Thursday to answer questions about the changes and instead directed questions to an agency spokeswoman.
Michelle Dahnke noted some of the added expenses, but also said that the estimates were revised because past federal programs have exceeded their cost projections.
"The agency believes the figures in the December presentation better reflect the probable costs to Floridians," Dahnke said in an email. "Given the current federal fiscal climate and the track record of the federal government in exponentially expanding beyond their original estimates with regard to health care costs, it is important for the state to consider the full ramifications of expanding Medicaid."