THE BLOG
04/18/2013 11:52 am ET Updated Jun 18, 2013

Florida's Medicaid Expansion Drama Continued: It's Obamacare vs. Grouponcare, Part I

It's too easy to just tell legislators that they are wrong. The harder path is to give them the facts and hope they don't ignore them.

With only three weeks of the legislative session left to go in Florida, the House knew they had to reveal their alternate plan to extending Medicaid, so no one could say that they did nothing to improve the plight of the uninsured -- so they offered less than nothing. They want to give away over $55 billion in Federal funds derived from the taxes we in Florida have paid to the government and give us... Groupon-Care. (I'll explain that name and explore that plan later.)

Rep. Schwartz (D-Hollywood) called it a "dog-and-pony show."

There is no dispute that low-income Floridians need some form of health care to keep them healthy and able to work, be good consumers and stay the heck out of the emergency rooms when there is no valid need for that type of expensive and inappropriate care for their non-emergent or episodic health problems. More than one in five residents of Florida has no health insurance. Even after you take out the number of undocumented immigrants, that is a hefty amount, and the third worst in the country. If you look at just the non-elderly adults, the numbers are every one in four that are self-pay, or no-pay.

At the core of the debate is whether or not to take the federal dollars offered by the government to cover the cost of Medicaid expansion to include all families under 138 percent of the poverty level- almost 1.2 million residents. For the first three years when the match is 100 percent paid by the Feds, the state would net $9.8 billion and almost $55 billion over the next decade.

That would come in handy, because the mandatory elements of Obamacare would cost the state plenty. Just the cuts in Medicare alone will cost $60 billion. You could also add in $2 billion in DSH (Disproportionate Share Hospital) funding lost -- that's the money that reimburses hospitals that pay for the uninsured that walk in their doors with no ability to pay, although the hospitals would have less no-pay self-payers if Medicaid was expanded, even if some of them still wandered into the ER instead of a primary care physician or Federally Qualified Health Clinic (FQHC) that they could now afford.

Then there is the case of the Medically Needy Medicaid (MNM) patients, of which I was one this last year.

The down side of MNM is that recipients must meet a "share-of-cost" before anything is covered. The plan was initially designed to help low-income individuals who have too much income for Medicaid (100 percent to 138 percent of the Federal Poverty Level (FPL) who have suffered a severe financial downfall from medical bills). Even the Speaker of the House, Will Weatherford's family used it when he was a kid in 1995 and he had a little brother who unfortunately succumbed to cancer. In my case, the share-of-cost prevented me from seeking primary care because I couldn't afford it, so I had no screening, examinations or tests to let me know that I was heading for a heart attack, which I suffered in November of 2012. Instead of handing the State Medicaid budget a $200 bill to cover the costs of a doctor visit and tests, I had a double-bypass surgery, two catheterizations with angioplasty and four stints, resulting in a hospital bill of $220,000 for the state to reimburse.

Medicaid expansion would have afforded me the chance to go to the doctor and avoid my heart attack, and avoid giving the state a humongous bill to cover. But the best part is that accepting Medicaid expansion would mean that the Feds would be covering the cost of Medically Needy program, resulting in savings of $436 million for this next budget year, over $4.5 billion in savings over the next decade and more savings from avoiding situations like mine or worse.

So, why not take the money? I was listening to the House debate when they were laying out and voting on the House Plan, which they called Cummings Care, for Rep. Travis Cummings (R-Orange Park), but which I prefer to call Groupon-Care (I'll explain that later). I heard the rhetoric, about how the Representatives on the right are concerned over deficit spending in Washington, which was brought on in large part for paying for a war that was enthusiastically supported, but not paid by members of their party in Washington.

I also heard concerns over stalemates, stagnation and sequestration (which have been brought on, for almost all parts, by their party members in Washington).

But one reason made me smile, almost in a way that Obama smiled during the second debate with Romney when the governor mentioned that the president did not acknowledge the incident in Bengazi as a terrorist attack. (Please proceed, Governor.) When it was time to give her concerns and recommendations, Rep. Passidomo (R-Naples) stated that we just cannot trust the Federal Government when it comes to promises made. Her example: "Somebody said that the government has never reneged on any of its promises. ... What about the Indians?"

First, I should give credit to Rep. Schwartz for mentioning the first part of that statement in committee.

In regards to the Indians, I think the first thing that we would have to do to remedy that would be to impeach Grover Cleveland for endorsing the racially-driven Dawes Act of 1887. Then we should go after the Roosevelt administration for cutting the budget of the Bureau of Indian Affairs and taking away over 400,000 acres from the Indian nations for among other things, a gunnery range and the land for the Japanese-American Internment camps. Truman is next on my hit list for setting up the Indian Claims Commission to hear Native American claims for any lands stolen from them since the creation of the USA in 1776. The commission had no intention of giving back land, only financial compensation, which didn't seem to be reaching the Native American nations, and eventually leading to Cobell v. Salazar. That humongous class-action lawsuit was filed in 1996, but severely delayed when Reagan-appointed Judge Royce Lamberth was removed from the case during the Bush administration for being to openly biased towards the Indians. The case was finally settled in 2009, leading to the Democratically lead Congress to create the Claims Resolution Act of 2010, signed into law by Barak Obama in December of 2010. It provided $3.4 billion for the settlement of the Cobell v. Salazar. $1.4 billion of the settlement was allocated to plaintiffs in the suit, and up to $2 billion was allocated for re-purchase of lands distributed under the Dawes Act.

Looks like someone finally kept the government's promise to the Indians. And it's the same folks offering the Great Donor State of Florida back the funds needed to provide healthcare to its neediest citizens.

Several representatives, including Rep. Woods(R- Winter Haven) and Rep. Roberson (R-Punta Gorda) crassly called the funds "Free Dollars," reiterating the tired adage of "There is no such thing as a free lunch." Dwight Dudley (D-St. Petersburg) aptly retorted, "It's not a magic pot of Money, It's Our money."

Rep. Mike Fasano (R-New Port Richey) made a truly valiant attempt to offer an amendment to the House plan that would accept the federal funds and come closer to the Senate's Negron Plan. It was summarily turned down, along party lines, of course.

Medicaid is not a perfect system. It's not meant to be. It's not a Cadillac Plan. It's a safety net. It is meant to cover as many as possible. It can be done with our tax dollars, that we all paid into on or before April 15th (hopefully) or we can have more of our tax dollars taken away from roads and education and spent on GrouponCare. (Stay tuned for my explanation on that in the next blog).

In the meantime, according to a poll by Associated Industries of Florida, a conservative business lobby, 60 percent of the state prefers Medicaid expansion, versus 28 percent who do not.

We loudly ask the House and Senate, for whom we have given our faith, trust and votes, to listen to the people (and even your governor) and take the money. It's ours, and we deserve to spend it on our state.