Imagining a Florida Without Medicaid

Categories: Health
Rick-Scott-Photo-hi-res_picnik.jpg
See also: Rick Scott's stranger-than-fiction smackdown of Obamacare and his defense of that decison.

In 2009, at least 2.45 million people in Florida were enrolled in Medicaid, according to data from government agencies. Another estimate pegs the number at more than 3 million. That's over a tenth of all people in the state and more than all of the people in the Tampa Bay area. All of those people are below the poverty line, and their health care is provided by a mix of federal and state funds.

But that huge population of the poor and vulnerable is now at the edge of a cliff. Republican Gov. Rick Scott is dead-set on shifting their health care to flat-rate, privatized care programs. And a portion of the Affordable Care Act that tried to build more padding into Medicaid eligibility landed with a thud in the U.S. Supreme Court chambers. Now, states are free to reject any expansion of Medicaid, as Scott did last week, when he vowed not to enforce Obamacare.

It's not too much of a stretch to imagine that the next step involves cutting Medicaid eligibility. The Affordable Care Act's proposed incentive was silly from the start: "If you don't expand Medicaid, we won't give you any money for Medicaid!"

Scott might have been OK with that. Then he'd have an excuse to divert poor folks to a private health-care market and save some state funds for corporate welfare or international vacations.

The part of the act that did survive the Supreme Court was the individual mandate, which (for all the Republican backlash right now) will effectively channel gazillions of dollars, under penalty of law, to large private health-insurance providers. Obamacare, as it turns out, represents a huge potential shift away from the remnants of single-payer that exist in Medicare and Medicaid and toward the "personal responsibility" of paying big corporations.

The Supreme Court decided that states can stay on the federal Medicaid dole even if they don't expand the ranks of the insured to those just above the poverty level. You're going to see a lot of Southern, Republican-led states turn down the money and maintain a fragile status quo. In 2009, Florida paid around 32 percent of an estimated $14,990,559,595 in Medicaid health-care costs.

Sixty-four percent of Floridians on Medicaid were on managed-care plans such as HMOs, like those favored by Scott and the Legislature, which last year passed two bills designed to reduce expenditures and pay more flat rates to for-profit managed-care providers.

"Medicaid in its current form is an out-of-control entitlement program which has become the single largest cost driver in our state's budget," said House Speaker Dean Cannon, who called Medicaid a "broken program." The Obama health-care reform assumed that states would step in line to keep their Medicaid funding. But with it so out of favor with those in charge and so full of bloated expenses, some might be dreaming of eliminating it.

What would a Florida with 3 million people who lost their health coverage look like? There are already signs of how private care sets up shop to generate healthy profits from sick, poor people.

On a PBS Frontline episode last week, reporters from the Center for Public Integrity delved into the records of for-profit dental clinics that serve children and adults with serious tooth decay who have slipped through the system without proper preventive care. Doctors are expected to meet quotas for numbers of patients served, more-expensive crowns are pushed on customers, and dentists are sometimes awarded bonuses for making more money. A lot of this, the report shows, channels funds from Medicaid programs. But there's another profit channel as well: good old American credit cards.

When a little old lady went into a dentist's office for repair work, she said she was conned into getting a "Hollywood smile" and shuttled off to sign up for a GM credit card that started accruing hefty interest the moment she signed on the dotted line, before the dentist started working on her teeth. For now, kids are protected by Medicaid and state-run CHIP plans, even if providers try to milk the system.

It's an inefficient way to pay for services, prone to manipulation at taxpayer expense. But what are the alternatives: Charity? Church fundraisers? Credit cards?

The U.S. government has failed to provide an enticing incentive that governors can turn around and sell to their mad-hatter right-wing voting blocs. Instead it was "expand the status quo or we won't give you the status quo." Medicaid is, as Speaker Cannon said, broken. But there's a thin layer of legislation between us and a world where there's no incentive to care for 3 million Floridians except for the opportunity to make a buck.




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4 comments
william
william

I have medicare, but would have had medicaid if I were under 65. Because of my advanced age, I don't know if I have any dental coverage. Half my mouth has started to corrode because 2 years ago all of my fillings began falling out. as so, the teeth began falling in half or breaking at the gum line. Now I have lost about 15 teeth. I dont know if anything is covered, but my families income is all social security and it nets about 1250 a month. my rent is $700, and I live month to month. I cant get a job because of my age. Even though age discrimination is illegal, most on line applications ask your date of birth or when you went to high school, so they know your age without seeing you and your personality. I expect to run out of money and live in my car. This makes getting a job even harder. Why does Florida make it so hard to get by. I expect crime to go up as some people get desperate. I can only afford to eat a snack 1 or 2 times a day. Republicans are trying to screw the poor, but we could have a civil war again if things dont get better.

Kenwalters
Kenwalters

This article is extremely misleading, just like most conversations on this topic. Medicaid is a program that is funded by both the state and the federal goverment. It is intended primarily for poor mothers and children under 19, disabled, sick, or indigent adults below 65, or those above 65 who have Medicare and may have Medicaid due to income limitations or nursing home residence. None of the states, including Florida, intend to opt out of that program. Obamacare expands this program to all healthy individuals who make $15k a year or a family of 4 that makes $31k a year. This is the part of the program that many states are going to choose to opt out of, as it represents unfunded mandates from the federal government.

william
william

I wont opt out. Otherwise we wont have any food and I WONT BE ABLE TO PAY RENT and will have to live in my car. It goes on, but you wouldn't want to be broke with no one willing to hire you. You are asking millions to commit suicide. I have almost given up as many have. Its a good thing that we are all allowed to have guns. If they come for us because we have no money I would rather go out in a blaze of glory taking as many with me as possible rather than lie down and die in vain. If the government is going to starve me and refuse my medical needs, My gun and me will not go quitely, and that is true for the millions in the same boat.

william
william

I get only about $1250 a monthhfrom social security fir my wife and me. I cant get a job because of my advanced years. My wife is disabled and has been certified as such by medicare's doctord. She needs surgery, but her finak papersw are mixed up in red tape for 4 months so far. In the meantime she has no movement of one arm because she has a tear in the muscle and needs surgery. She has been told she will be crippled if she doesnt ge surgery soon. She also lost 90 % of her hearing 2 years ago and we cant talk anymore because she cant hear. a brain surgerywould fix this with aan implant but still no health care, She could be working and paying taxes, but instead she needs foodstamps to eat and pays no taxes, If our laws helped everyone willing to retrain for a skill we could gradually give out needed skills to those who want it. Instead we allow them to chose getting a skill or wanting suicide. Crime is the third. If you could wave your wand do you want everyone to work in a job that needs skilled people, or allow them to avoid taxes and get a safety net?

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