House, Senate Still Stuck in Health Debate

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TALLAHASSEE — A rare June special session began Monday with legislative leaders promising to get done with the unfinished business left over from their annual spring meeting: passing a spending plan for the budget year that begins July 1.

But on the main issue that bitterly divided the House and the Senate more than a month ago — whether to adopt a Senate proposal aiming to extend health-care coverage to hundreds of thousands of lower-income Floridians — the two sides seemed as far apart as ever.

The Senate continued to push for its plan to use federal Medicaid expansion dollars from the Affordable Care Act, more commonly known as Obamacare, to help those Floridians purchase private health insurance. But the House continued to push back just as hard, amplifying its objections in an afternoon committee meeting that highlighted an array of questions about the proposal.

House Speaker Steve Crisafulli, R-Merritt Island, said that he continued to object to the plan as a form of Medicaid expansion, despite Senate attempts to counter that criticism.

A new version of the Senate proposal issued last week would get rid of an interim period where the state would put people in Medicaid managed-care plans while waiting to hear whether the federal government would approve the Senate’s longer-term proposal on private insurance.

“It’s still Medicaid expansion,” Crisafulli told reporters after a brief House session Monday. “It uses the Medicaid population, it uses the Medicaid dollars, and it uses the program rules. It’s Medicaid expansion.”

House leaders plan to hold a vote on the Senate proposal this week, but it seems unlikely that the proposal could pick up the 20 or Republican defections it would need, depending on how many lawmakers vote, for approval. Crisafulli said members would not face retribution if they vote for the program.

“Our members will take the information that’s given to them and make a determination based off of that,” he said.

Senate President Andy Gardiner, an Orlando Republican who has spearheaded the push for the program, seemed to nod toward the obvious even as he held out hope. He would not directly answer whether a negative House vote would mean the Florida Health Insurance Affordability Exchange, or FHIX, proposal is dead.

“I’m hopeful that they pass it,” he said. “I do think that the votes are there to potentially pass it. But it’s not going away. It just isn’t.”

Even House Democrats, who have cheered on the bipartisan Senate majority that backs FHIX, conceded that House Republicans seemed unlikely to budge.

“It wouldn’t surprise me to see a budget completed on time, but for there not to be any expansion,” said House Minority Leader Mark Pafford, D-West Palm Beach.

The two chambers held dueling committee meetings Monday afternoon to tout the advantages and disadvantages of the Senate’s approach.

The Senate Health Policy Committee unanimously passed the revised proposal, known as “FHIX 2.0,” sponsored by committee Chairman Aaron Bean, R-Fernandina Beach.

The FHIX program would offer coverage to approximately 800,000 Floridians earning less than 138 percent of the federal poverty level. They would receive premium credits to shop for products on the FHIX marketplace or the federal health insurance exchange or plans offered by Florida Health Choices or the Florida Healthy Kids Corporation.

Under the program, parents with children under the age of 18 would have a minimum work requirement of 20 hours per week, while childless adults would have a minimum requirement of 30 hours per week.

Sen. Don Gaetz, R-Niceville, walked Bean through a series of questions intended to establish that the proposal would be “a coverage opportunity, not a coverage entitlement, for hundreds of thousands of Floridians.”

Given the work requirement, Bean said, 400,000 to 500,000 Floridians would be eligible for coverage under the Senate plan. Theoretically, the number could go as high as 800,000, but according to Senate staff, approximately 48 percent of potentially eligible Floridians would not meet the work requirement.

Gaetz said that although he’s a staunch opponent of Medicaid, Bean had “drawn a distinction, in this bill, between those who can’t get up off the couch and those who won’t get up off the couch. … This doesn’t expand Medicaid by one jot or tittle.”

Meanwhile, Republican members of the House Health & Human Services Committee savaged the plan’s shortcomings. Of the five significant waivers of federal law that would have to be approved by the federal government, the committee said, three were unlikely to get the go-ahead.

Those likely to be rejected by the U.S. Department of Health and Human Services include the work requirement.

“It really leads me to believe quite frankly that we’re having a really lengthy discussion on a program that has very little likelihood of being approved by the federal government,” said Rep. Colleen Burton, R-Lakeland.

Gardiner said the state should find out whether the state can win approval.

“I think it’s important for us to tell … the federal government that if you want to expand coverage here, at least from the state of Florida, this is as far as we can go,” he said.

During the committee meeting, House members also pointed out that the plan would likely fall well short of covering the 800,000 people supporters often say it would; could cause premiums to spike for the families of almost 159,000 low- to middle-income Florida children who already receive health-care from the state; and would end a program that helps state residents whose incomes are too high for Medicaid but who can’t afford their medical costs.

Between those changes and the fallout in the private insurance market, state Medicaid director Justin Senior said, “it would be difficult to predict whether more Floridians would gain coverage or lose it. It would be a very close call.”

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