After weeks of criticizing a potential expansion of the Medicaid program, House Republican leaders Thursday released an alternative plan that would provide $2,000 health-care subsidies to targeted groups of low-income parents and people with disabilities.
The plan would reject tens of billions of dollars in federal money that would be available during the next decade to expand Medicaid eligibility under the federal Affordable Care Act. It would take what a key architect, Rep. Richard Corcoran, R-Land O’ Lakes, described as a “free market” approach to offer health services to low-income people.
“The Florida House has developed a plan that will fit the needs of Florida, not the requirements of Washington,” House Speaker Will Weatherford, R-Wesley Chapel, said in a prepared statement.
But Gov. Rick Scott quickly raised doubts about the plan because it would rely on state money and not tap into funds available through the Affordable Care Act, sometimes called Obamacare. Scott in February announced support for the Medicaid expansion and also has backed a Senate alternative that would use federal money to help low-income people buy private insurance.
“The House’s plan will cost Florida taxpayers on top of what they are already taxed under the president’s new health-care law,” Scott said in a statement. “This would be a double-hit to state taxpayers.”
The plan’s release sets the stage for the House and Senate to try to reach agreement in the coming weeks about trying to expand health coverage for low-income Floridians. Republican leaders in both chambers have rejected expanding Medicaid as intended under the Affordable Care Act, but the Senate is considering two alternatives that differ from the House plan.
Under the plan dubbed “Florida Health Choices Plus,” House Republican leaders would offer the subsidies to low-income parents and people with disabilities who are eligible for the federal Supplemental Security Income (SSI) program. The plan would only be open to people who have household incomes at or below 100 percent of the federal poverty level — a maximum household income of $19,530 for a family of three.
People who enroll in Florida Health Choices Plus would be required to pay $25 a month and meet work requirements. Materials released by the House indicate, for example, that enrollees could use the subsidies to help buy high-deductible, catastrophic insurance coverage.
Florida Health Choices Plus would start in April 2014 and, according to the House, would enroll an estimated 116,000 people a year. The vast majority of those enrollees would qualify because they are parents, not because they are eligible for Supplemental Security Income, according to House materials.
The subsidies would cost the state an estimated $237 million a year, though the amount in the upcoming 2013-14 fiscal year would be only $12 million because of the April 2014 start date. The House wants the Florida Health Choices program — a long-planned state health marketplace — to run Florida Health Choices Plus.
The plan, however, likely will face opposition from Democrats and other groups that have backed expanding Medicaid under the Affordable Care Act. Such a Medicaid expansion would cover hundreds of thousands of more Floridians than the House plan and also would guarantee more-complete coverage.
House Minority Leader Perry Thurston, D-Fort Lauderdale, released a statement Thursday describing the House plan as a “bare-bones health coverage plan.” But he also said he recognizes that it is “at least a minimal attempt toward achieving a legislative compromise on the important topic of health coverage for Floridians.”
The Affordable Care Act calls for expanding Medicaid to people whose incomes are up to 138 percent of the federal poverty level. Also it says the federal government would pay all of the expansion costs for the first three years and gradually reduce its share to 90 percent in 2020. That would lead to Washington spending more than $50 billion in Florida over 10 years.
House Republican leaders have repeatedly raised questions about whether the state could rely on the federal money in the future and have said they fear Florida would get stuck picking up large part of the tab for expanding Medicaid.
The House proposal would rely on another part of the Affordable Care Act as a way for people whose incomes are between 100 percent and 138 percent of the poverty level to get coverage. That part of the law will offer subsidies to people to buy coverage through a health-insurance “exchange,” a type of online marketplace.
Under the House proposal, the $2,000 subsidies would go into accounts, known as CARE accounts that would be administered by Florida Health Choices. Enrollees could use the money to buy coverage and health services.
The Senate proposal that Scott has backed was proposed by Senate Appropriations Chairman Joe Negron, R-Stuart. It would rely on federal money to help people up to 138 percent of the federal poverty level get insurance.
The House proposal, in some ways, is similar to another proposal released by Senate Health Policy Chairman Aaron Bean, R-Fernandina Beach. Both would reject federal money and target uninsured people with incomes at or below 100 percent of the federal poverty level.
House Republicans and Bean also agree they do not want to create an “entitlement” program and would rely on the Florida Health Choices program as a key vehicle. They even propose similar program names, with Bean calling his the “Health Choice Plus Program.”
But Bean’s proposal would offer smaller amounts of money to more people than the House would.
by Jim Saunders
