Despite several changes made in recent days to assuage the concerns of the Republican majority, the Florida House remains poised to defeat a health-care expansion plan backed by a bipartisan group of senators.
More than two hours of questioning on the House floor Thursday gave little reason to believe that the bill (SB 2-A) would survive a vote scheduled for Friday. For all of its new provisions, House Republicans said, the so-called Florida Health Insurance Affordability Exchange, or FHIX, remains Medicaid expansion in disguise.
The plan, approved by the Senate on Wednesday in a 33-3 vote, would use Medicaid expansion funding from the Affordable Care Act --- commonly known as "Obamacare" --- to help lower-income Floridians purchase private health insurance. If approved by the federal government, the plan would also give the state increased federal funding levels for the newly eligible Floridians.
That, GOP House members said, is proof enough of nature of the idea.
"If the plan is dependent on the 90 percent federal match rate outlined in the ACA (Affordable Care Act), and it's a requirement that we serve the exact population defined by the ACA, would you not agree that this plan is truly Medicaid expansion as envisioned by the ACA?" asked Rep. Matt Caldwell, R-North Fort Myers, questioning Rep. Mia Jones, D-Jacksonville.
Jones was thrown into the unusual role of defending a bill she hadn't crafted and openly admits is flawed. No Republican from the House majority could apparently be found to present the measure, though a few are expected to vote for it Friday.
"I call this the Florida expansion," Jones said during the discussion of the bill. "It does not immediately or at any point put the participants into Medicaid."
Shortly before the debate began, the White House Council of Economic Advisers issued a report saying Florida could insure an additional 750,000 people and bring in an extra $5.9 billion in federal funding by adopting Medicaid expansion, though it wasn't clear exactly how those numbers might be different for FHIX.
Supporters say as many as 800,000 Floridians would meet income limits for health care under the plan, though work requirements likely mean that only 400,000 to 500,000 people would actually be eligible.
The White House report also rebutted the notion that states could end up paying more under Medicaid expansion. According to an analysis by the state House Majority Office, the new FHIX plan would save money initially but then cost the state an additional $66.3 million in its tenth year.
"States electing to expand their Medicaid programs are likely to realize large savings in other areas of their budgets that offset even the modest increase in state Medicaid spending after 2016," the White House report says.
In any case, Republican and Democratic leaders said they don't expect the bill to pass the House. Republicans hold an 81-39 majority, though some members of both parties are out of town, and could afford to have about 20 members defect without losing the vote.
Still, some Republicans hammered away at FHIX.
"How can we and most people not see this as a potential massive tax hike on the people of this great state of Florida?" asked Rep. Blaise Ingoglia of Spring Hill, who doubles as chairman of the Republican Party of Florida.
Jones and House Minority Leader Mark Pafford, D-West Palm Beach, said the measure is not what they would have proposed, but represents the best chance to get something like Medicaid expansion done during the ongoing special legislative session, which was called to deal with health care and the budget.
"I don't think there's a single member of the Legislature that's happy with this bill, including us," Pafford said. "We're not thrilled (with) the way it's written."
House Speaker Steve Crisafulli also seemed to rule out a compromise idea that Senate leaders had proposed Wednesday, when they suggested that some reforms House leaders have pushed could be added to the bill and approved by the Senate. The House is looking to revamp insurance coverage for state workers and overhaul some longstanding health-industry regulations.
But Crisafulli, R-Merritt Island, said that wouldn't be enough to get House leaders to accept the Senate plan.
"No, it's still got its flaws," he told reporters. "It's Medicaid expansion, regardless of what others say."
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