Refusing to go along with Republican Gov. Rick Scott and angering Democrats, a House select committee Monday opposed a major expansion of the Medicaid program under the federal Affordable Care Act.
The 10-5 vote, along party lines, was the first time lawmakers have taken a formal stance on the highly controversial Medicaid expansion as this year's legislative session prepares to start --- and signaled that House Republicans are dug in against the idea. Speaker Will Weatherford, R-Wesley Chapel, quickly issued a statement saying the expansion would not be in the state's best interest.
Weatherford and Republicans on the select committee questioned whether the federal government would be able to make good in the coming years on its promise to pay the vast majority of costs of expanding Medicaid eligibility to hundreds of thousands of additional Floridians.
"Can anybody honestly say they have a clear, decisive view of what the federal government's budget picture is going to look like for the rest of this year, let alone for a decade?'' asked Rep. Matt Hudson, R-Naples. "Think about that. The federal government has had a challenge almost every single day over the last six months. And yet somehow we are to believe that they will be rock-solid, nothing will change for a decade."
But the top Democrat on the panel, Rep. Elaine Schwartz of Hollywood, accused the Republicans of being short-sighted and motivated by ideology as they voted against a key part of the federal health law better known as Obamacare. Democrats rejected the notion that the federal government would not pay for the expansion.
"This is a no-brainer,'' House Minority Leader Perry Thurston, D-Plantation, said. "This (the vote against expansion) is the wrong decision to make."
Weatherford and select committee Chairman Richard Corcoran, R-Land O' Lakes, had already said they were skeptical of the expansion, so Monday's vote was not a big surprise. But with the 60-day legislative session starting Tuesday, it added to the uncertainty about whether Scott and both chambers of the GOP-controlled Legislature will be able to reach agreement on the issue.
A Senate select committee postponed a meeting, scheduled for Monday afternoon, that was expected to include discussion about moving forward with the Medicaid expansion. Chairman Joe Negron, R-Stuart, said he had asked Senate President Don Gaetz, R-Niceville, for additional time for members to consider the issue and that he expected the committee to make a recommendation early in the legislative session.
"It's more important to get it right than to get it done quickly,'' he said.
Florida Republicans leaders have long opposed the Affordable Care Act, which Obama and congressional Democrats approved in March 2010. But Scott drew national attention last month when he supported a plan to go along with the Medicaid expansion for three years and then revisit the issue.
The federal government has promised to pay 100 percent of the expansion costs during the first three years and then gradually scale back its share to 90 percent in 2020, with the state responsible for the remainder. The expansion would make coverage available to people whose incomes are up to 138 percent of the federal poverty level, including childless adults --- a group that is now largely ineligible in Florida's Medicaid system.
State economist Amy Baker presented a report Monday that estimated nearly 869,000 people would be part of the Medicaid expansion, though many of those would be shifted into the program from other types of coverage. As an example, children who are currently eligible for a program that offers subsidized health insurance to working families would be shifted into Medicaid if they met the new income qualifications.
The House, Senate and Scott administration have already rejected another part of the Affordable Care Act that could have involved the state running a health-insurance exchange, an online marketplace where people can shop for coverage. In doing so, the state will default to the federal government running the exchange in Florida.
But the Medicaid expansion issue has been more controversial and, depending how the Senate wants to handle it, could continue looming throughout the legislative session. While conservative groups such as the James Madison Institute oppose the expansion, other groups such as the Florida Hospital Association are lobbying heavily for it.
Opponents of the expansion Monday raised issues such as whether Florida's health-care industry would have an adequate workforce to handle a massive influx of new Medicaid beneficiaries. Also, they repeatedly returned to the argument that the state cannot rely on the federal government and that Florida might get stuck with paying a large amount of the Medicaid expansion costs in the future.
"This is a free lunch, and after three years, what's the guarantee that they're (the federal government) going to be able to pay?" asked Rep. Ken Roberson, R-Punta Gorda.
But after the meeting, Thurston said providing Medicaid coverage would help save people's lives and called the Republicans' opposition "morally reprehensible."