By Nic Horton, Jonathan Ingram, and Josh Archambault— Mr. Horton is a Policy Impact Specialist, Mr. Ingram is Research Director, and Mr. Archambault a Senior Fellow at the Foundation for Government Accountability.
The Florida hospital lobby is persistent, to say the least. Barely two years after the Florida Legislature defeated Obamacare Medicaid welfare expansion, the hospital lobbyists are back at it, rolling out yet another Obamacare expansion plan, this time with the help of local chambers of commerce and other groups. The hospitals’ new coalition even has a clever name for itself: “A Healthy Florida Works.”
These actions have prompted some speculation that Florida lawmakers may flip flop on their principled opposition to this massive expansion of Medicaid welfare. Insiders are also reporting that the hospitals are preparing to dump even more money and resources into lobbying for Obamacare expansion—on top of the more than 250 lobbyists hospitals already deploy to Tallahassee every year.
In the past, lawmakers have taken a thoughtful, careful approach to the Medicaid expansion question. After setting up a special committee to study every aspect of the issue and gathering all the facts, they rightly rejected every effort to implement it – even when that meant standing up to a wavering Republican governor, the chairman of the Democratic National Committee, and the full force of the Obamacare lobby.
In 2013, current House Speaker Steve Crisafulli and Speaker Designate Richard Corcoran (current chairman of the Appropriations Committee) were among the most vocal leaders of a large majority of Florida legislators who opposed Obamacare expansion. They both deserve immense credit for their courage to do what was right, even in the face of pressure from hospitals, Gov. Rick Scott and other Obamacare lobbyists.
Going forward, Florida lawmakers must resist the pressure to flip flop. A marketing rebrand can’t change the facts: Obamacare Medicaid expansion is devastating policy for taxpayers, the truly needy, and the state’s economy.
Call It “Healthy Florida,” But It’s Still Obamacare Expansion
Hospitals’ latest strategy is simply to re-brand Obamacare expansion with free-market buzzwords. But there’s nothing “free market” about creating a new welfare entitlement. Here’s what we know about the hospitals’ plan at this point:
Despite the claim that it’s a true “alternative,” the so-called “A Healthy Florida Works” would cover the same able-bodied, working-age adults that every other Obamacare expansion does. Nearly 83 percent of these potential enrollees have no dependent children and nearly half don’t work at all, despite having no disabilities keeping them from meaningful employment.
And according to President Obama’s own Department of Justice, up to 35 percent of expansion enrollees nationwide will have checkered criminal pasts, including time served in prison or jail, or on probation. This is the group Florida’s Big Hospital lobby wants to add to welfare – and its willing to spend loads of cash to do it.
This new Obamacare expansion plan would rely on the existing Medicaid managed care system to deliver all regular Medicaid benefits to the new welfare enrollees. Cost sharing would be capped at the nominal levels Medicaid allows. Enrollees would be legally classified as Medicaid enrollees, making them entitled to all the same protections as other Medicaid enrollees. The plan would operate under a Medicaid waiver, would need an amended Medicaid state plan to implement and would be funded through the Medicaid program.
Simply put, this is an Obamacare Medicaid expansion plan. New labels and buzzwords can’t change these basic facts.
An Imaginary Work Requirement
One of the few tweaks “A Healthy Florida Works” has proposed is the creation of work-search requirements for able-bodied adults signing up for Obamacare expansion. Under the proposal, enrollees would need to participate in employment-search activities, on-the-job training, job placement or educational opportunities in order to continue receiving Obamacare.
This is nothing new. A number of governors have proposed work requirements as window dressing for their Obamacare expansion plans. But Obama officials have rejected these proposals every single time they have come across their desks. They won’t even approve “work-search” or “work-effort” requirements. At most, states have been able to create voluntary work assistance programs that don’t affect eligibility at all, and often have to be funded with state only dollars. Nothing is stopping states from funding such job activities now, and expanding Medicaid with all of its unintended consequences is clearly not required.
The Big Hospital lobby knows this. But it also knows that states don’t walk away from Obamacare expansion when the federal government rejects work-related tweaks.
Fake and Unenforceable Premiums
“A Healthy Florida Works” also proposes “mandatory” contributions to “Healthy Benefits Accounts.” Pending federal approval, contributions would range from just $3 to $25 per month. The funds would be deposited into accounts and enrollees could use those funds to pay for over-the-counter drugs or health services not covered by Medicaid. (All Medicaid services will be paid for by taxpayers.)
But based on the experience of other states, even if Florida were to receive permission to mandate these contributions, the mandates will simply operate as mere suggestions, rather than actual requirements. The Obama administration has consistently rejected state-led efforts to impose meaningful consequences for refusal to pay premiums. Paying premiums becomes merely a suggestion. But even if approved, the Healthy Benefits Accounts won’t serve as any kind of meaningful “skin in the game.” Instead, they would operate as small payments that enrollees will get to keep and use for other expenses.
Nothing New Under The Sun
There’s nothing in this latest welfare expansion proposal that addresses any of the concerns Florida lawmakers have expressed for years.
“A Healthy Florida Works” would create a massive new welfare cliff, discouraging work and potentially causing up to 200,000 able-bodied adults to drop out of the labor force. The plan would rely on funding from a bankrupt federal government that nobody believes will actually be there. Worse yet, it would put the truly needy on the Medicaid chopping block while able-bodied adults are moved to the front of the line.
No amount of window dressing can fix the enormous political, financial, and moral costs of Obamacare’s disastrous Medicaid expansion. Florida lawmakers have taken a thoughtful, careful approach to the Obamacare question in the past. Many of them are confronted with this plan to expand Obamacare once again. Flip flopping would be a terrible mistake.
This post originally appeared at Forbes on March 5, 2015.