Aaron Bean looks for another Medicaid alternative

Aaron Bean
Aaron Bean

TALLAHASSEE, Fla. – Offering few details, Senate Health Policy Chairman Aaron Bean on Wednesday said he is working on a proposal to help provide health services to hundreds of thousands of the lowest-income Floridians -- while rejecting federal money targeted for a Medicaid expansion.

Bean, R-Fernandina Beach, said he does not want to create an entitlement and also doesn't want to be tied to requirements that would come with Medicaid money under the federal Affordable Care Act.

"There's not just strings attached,'' Bean said. "There are metal chains attached to that money."

But Bean appears to be bucking another plan that Senate Appropriations Chairman Joe Negron, R-Stuart, is expected to formally introduce Thursday. The plan, dubbed "Healthy Florida," would use federal money to provide private health insurance to people who otherwise would qualify for the Medicaid expansion.

Negron's proposal appears to be gaining momentum, as Gov. Rick Scott on Tuesday indicated to the Times/Herald Tallahassee bureau that he likely would support the concept. Also, the Florida Hospital Association, which has lobbied heavily for Medicaid expansion, signaled Wednesday that it would support the proposal.

"It is a very promising alternative to Medicaid expansion that provides coverage to a million or more working, low income Floridians,'' hospital association President Bruce Rueben said in a prepared statement. "We look forward to working with lawmakers and other stakeholders to further develop this innovative approach."

House Minority Leader Perry Thurston, D-Fort Lauderdale, also offered support for the idea Wednesday. He pointed to estimates that showed the federal government would spend about $51 billion over the next decade on a Medicaid expansion in Florida, with the state responsible for about $3.5 billion.

"Whatever you want to call it, if it provides the services to the needy members of Florida's society, we're all for it," Thurston said.

Bean, however, is an example of the hurdles that the Negron proposal could face among some Senate Republicans --- and in the Republican-controlled House. Hailing from a conservative district in the northeast corner of the state, Bean said he is looking for ways to provide access to care without taking the billions of dollars in Medicaid money under the federal law better known as Obamacare.

"What can we say yes to?" Bean said.

As part of its goal to dramatically expand health coverage to almost all Americans, the Affordable Care Act calls for providing Medicaid coverage to people with incomes up to 138 percent of the federal poverty level. In Florida, that would have the biggest impact on childless adults, who are largely shut out of the state's current Medicaid system.

But House and Senate Republicans have rejected an expansion of Medicaid, leaving them to look at other alternatives.

Negron's proposal would target that same group of people as the Medicaid expansion, though he and others say a key distinction is that the Healthy Florida program would provide coverage through private insurers instead of Medicaid. If lawmakers go along with Negron, the proposal would need federal approval.

Bean wants to rely on another part of the Affordable Care Act as a way to cover people whose incomes are between 100 percent and 138 percent of the federal poverty level. Those people would qualify for subsidized coverage through a health-insurance exchange, a type of online insurance marketplace that will start operating next year.

In taking that approach, the state would not be involved in providing or financing the coverage.

"That's not us,'' Bean said. "That's not our state creating this entitlement program."

But a key problem centers on people who fall below 100 percent of the federal poverty level and are not currently eligible for Medicaid. Those people --- Bean said they are estimated at 600,000 --- also would not qualify for coverage through the exchange, and the state likely would be saddled with huge costs if it wanted to provide health care to them.

Bean briefly discussed his approach Wednesday during a meeting of the Health Policy Committee, but he did not have a written proposal. He indicated he wants to better coordinate care through entities such as county health departments, federally qualified health centers and the Florida Health Choices program, another type of online health marketplace that is on the drawing board.

"We're trying to look at what we can do within our means,'' Bean said.