May 4, 2020
The Patient Protection and Affordable Care Act of 2010 (ACA or “Obamacare,” colloquially) enabled and induced states to expand Medicaid to childless adults who earn up to 138% of the federal poverty line. These provisions of the ACA, effective January 1, 2014, provided a federal medical assistance percentage (FMAP) of 100% for calendar years 2014–2016, 95% for 2017, 94% for 2018, 93% for 2019, and 90% for 2020 and thereafter, meaning that Medicaid expansion is overwhelmingly federally funded, to the benefit of the states and their residents (“the carrot”). Furthermore, states were induced to accept Medicaid expansion as a corequisite to continue receiving existing Medicaid funding (“the stick”).
In 2012, the Supreme Court ruled “the stick” to be unconstitutional (National Federation of Independent Business v. Sebelius). Therefore, states are permitted to reject Medicaid expansion without endangering their existing federal Medicaid funding. State legislatures and governors in the southeastern United States have overwhelmingly rejected Medicaid expansion, despite tremendous financial and public health costs.
In Florida, which as of May 4, 2020 continues to opt out, Medicaid expansion would provide healthcare to an additional 800,000 low-income residents, and a 2014 analysis estimated that the 10-year costs (2013–2022) to the state would have been $5.36 billion in order to receive $66.1 billion of federal Medicaid funds and $22.6 billion of additional hospital reimbursements, for a total of $88.7 billion of federal funds—a net gain of $83.3 billion to the state, its residents, and its healthcare providers. To put this in perspective, the entire proposed state budget for the 2020–2021 fiscal year is only $91.4 billion.
Florida’s refusal to expand Medicaid bankrupts, impoverishes, sickens, disenfranchises, and kills Floridians, and is effectively a bailout of blue, Democratic states that accepted the expansion of Medicaid. The ACA obligates the federal government to provide funding to states that accept the expansion. Florida’s reticence on this matter has, over the past 6 years, 4 months, and 4 days, cost the state, its residents, and its healthcare providers over $56 billion in federal funds that would otherwise have been disbursed.
As a progressive Democratic congressional candidate for Florida’s 6th district, I believe our eventual goal as a nation should be universal healthcare for all Americans, devoid of insurance schemes, premiums, and deductibles. A step along this path is nationwide Medicaid expansion as provided for in the ACA—a humanitarian triumph that sadly, has still not been realized.
Florida’s former governor and now U.S. Senator, Rick Scott, complains that Medicaid expansion would provide unnecessary welfare payments to able-bodied adults who shirk work out of greed and laziness. This rhetoric is damaging and false. Health insurance is extremely expensive, and many employers do not provide health insurance to the bulk of their employees nor to their independent contractors. Moreover, qualifying for a federal subsidy of health insurance premiums on the HealthCare.gov exchange requires earning no less than 100% of the federal poverty line, only to receive policies with high deductibles, co-pays, co-insurance costs, and out-of-pocket annual maximums that may be as high as $16,300. In contrast, Medicaid, where accepted, pays 100% of costs, which is vastly superior for Floridians, as well as for many healthcare providers who are happy to accept lower reimbursement rates in exchange for guaranteed payments and a reliable customer base.
The coronavirus pandemic has resulted in widespread illnesses, unemployment, and lost healthcare coverage. Now, it is clearer than ever that Florida’s refusal to expand Medicaid is senseless cruelty. At the same time, Florida and other southeastern states have collectively missed out on hundreds of billions of dollars of federal funding that the rest of the country has enjoyed since 2014.
One recurring proposal in congress is to amend subsection (y)(1) of Section 1905 of the Social Security Act (42 U.S.C. 1396d) to grant an FMAP of 100%, rather than 90%, to states that agree to expand Medicaid now. The original wording provided 100% for calendar years 2014–2016, 95% for 2017, 94% for 2018, 93% for 2019, and 90% for 2020. The proposal is to simply shift this timeline forward, so that if Florida were to expand Medicaid now, they would receive 100% for 3 years, 95% for 1 year, and so forth until reaching a 90% FMAP. Although Florida and other southeastern states would not be able to re-coup the federal funds they missed out on over the past 6 years, 4 months, and 4 days, they would at least receive as sweet an offer (“the carrot”) as was initially available beginning on January 1, 2014.
Unfortunately, these congressional bills keep failing to gain widespread traction even among Democrats. In the 116th Congress, Senator Warner introduced the States Achieve Medicaid Expansion Act of 2019 (S.585) on February 27, 2019, which garnered only 8 cosponsors. In the House of Representatives, Rep. Veasey introduced the Incentivizing Medicaid Expansion Act of 2019 (H.R.584) on January 16, 2020, which picked up 36 cosponsors. Two weeks later, instead of cosponsoring H.R.584, Rep. Lewis introduced the nearly identical Medicaid Expansion Parity Act of 2019 (H.R.909), which gained only 2 cosponsors. These bills have repeatedly been introduced to little fanfare since the 114th Congress and are all exceedingly short, seeking only to offer the original FMAP cost-sharing timeline to southeastern states who are already significantly disadvantaged, having squandered their claims to hundreds of billions of dollars of pledged federal funds.
I believe passing such an act would incentivize states like Florida to expand Medicaid, to the benefit of over 800,000 Floridians and thousands of healthcare providers. The public has woken up and increasingly is rejecting anti-Medicaid rhetoric from Senator Rick Scott, Governor Ron DeSantis, and others. When you elect Richard Thripp as your congressman for Florida’s 6th district on November 3, 2020, I will immediately begin working to convince my colleagues of the necessity of rejiggering the FMAP timeline so that disadvantaged Floridians and other southerners can begin receiving the healthcare that residents of Democratic-led states have enjoyed since 2014. Six years, 4 months, and 4 days is enough. We cannot tolerate being forgotten and left behind any longer. Floridians deserve so much better!
Richard Thripp, Ph.D.
Progressive Democrat for U.S. Congress, Florida’s 6th District
My campaign is completely grassroots and volunteer-based.
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