Context Florida: Health care pits RINOS vs. Tea Partiers in budget fight

By Jack Stevenson

The ideological fissure that cleaves the Republican Party nationwide will be on display in Tallahassee as the legislative leadership labors to bring the state budget in for a landing by May 1. The critical issue, which on its face is about as exciting as watching paint dry, is whether to accept federal money to indirectly expand Medicaid through subsidized private health insurance, an option offered to the states by Obamacare.

Accepting this Medicaid expansion money would eventually provide basic health care coverage to a million souls who have no health insurance now. The federal government is committed to pay 100 percent of the approximately $5 billion average annual cost of expansion next year. Federal funding would then decline incrementally until the federal contribution after five years would be 90 percent, with the state paying the 10 percent difference.

That’s the carrot. The stick is the threat by the feds to end another program known as the Low Income Pool, or LIP, which provides $1.3 billion annually in federal money that is distributed by formula to Florida hospitals to lessen the burden of the uncompensated care that they render to patients who are uninsured and unable to pay.

The business community and health care providers are pressing hard for both Medicaid expansion and the renewal of LIP in the belief that faint heart ne’er fair lady won. The bottom line for the proponents is their balance sheets, but they did not fall off the turnip truck yesterday. They know compassion sells better than accounting, so they carry the righteous cause of the uninsured ill before them like the True Cross. Their champion is the Florida Senate, where a business friendly – and, of course, a caring – Republican majority led by what passes for moderates these days has sent to the House of Representatives a bill expanding Medicaid and a budget that spends both the new Medicaid money and LIP.

In the House stands a stone wall. The leadership of the Republican super majority there has adamantly opposed Medicaid expansion since Day One of Obamacare. It does not believe the feds can be trusted to keep their word on funding, and it fears they will change the programatic rules of the game after the fact, leaving state government holding the bag. The potential termination of LIP is cited as proof positive of federal perfidy. The House leadership also believes Medicaid in any guise is an inefficient, wasteful means of funding health care.
Undaunted by federal threats, the House has not even included LIP money in its budget. House policy at this point appears to be a modified version of Matthew 26:11: “The poor will be with you always, and some of them are bound to be sick, so get over it.”

At the heart of this implacable opposition to Medicaid expansion lies the long shadow of the Tea Party, with its visceral antipathy for Obamacare in all its manifestations and an abiding suspicion of the federal government and all its works. House Republicans are even more sensitive to the prejudices of “the base” than Senate Republicans are to the preferences of the business community.

The governor, who included LIP but not Medicaid expansion in his proposed budget, occupies the middle ground in this fight, from which vantage point he watches and waits. He has friends in both camps, and he supports his friends.

The table is thus set for the alleged RINOs in the Senate and the Tea Party proxies in the House to go at it mano a mano in a legislative Lights Out Cage Match. It is frequently the case,
however, that the trailers for these productions are more dramatic than the movie itself. If the past is indeed prologue, Armageddon in Tallahassee is unlikely.

If the feds do pull the plug on LIP, then the Senate likely will dig in and fight for Medicaid expansion in some form to protect hospitals from an unsustainable financial burden for uncompensated care. Legislators might anger long suffering spouses by missing planned summer vacations because of the resulting special session, but the House, after protecting its right flank by protracted resistance, would probably be dragged snarling and snapping to a compromise, something with tighter eligibility standards and tougher work requirements than the Senate proposal, for example. Or an uncompensated care program like LIP might be created and funded with state dollars in lieu of Medicaid expansion.

But if the feds blink and kick the can down the road by extending LIP once again, the Senate may opt for the status quo after appropriate face saving fulminations rather than going to the
mattresses in pursuit of total victory against an emboldened House that is not backed into a corner by an impending crisis.

In either event, the show on which the curtain is now rising in Tallahassee is going to be well worth watching even if you don’t have skin in the game.
Column courtesy of Context Florida.