Kathy Castor on LIP program and observing the ACA on trial at the Supreme Court

Gov. Rick Scott said Wednesday that if the state and the federal government can’t come to an agreement on Florida’s Low Income Pool (LIP) program, he won’t supplement the program with state funds.

“Florida taxpayers fund our federal government and deserve to get a return on their investment,” Scott wrote in a letter to President Barack Obama. “Moreover, we have worked hard to turn Florida’s economy around and cannot afford to fund programs started by the federal government.”

The $2 billion LIP program, which reimburses hospitals that treat large numbers of poor and uninsured patients, is scheduled to expire on June 30. The state Agency for Health Care Administration is hoping to reach a deal with the federal government to keep the federal portion of the funding in place.

But Tampa-area U.S. Rep. Kathy Castor says that certainly won’t happen before the May end of Florida’s legislative session.

“They’re just in the initial stages of conversation,” said the Tampa congresswoman, who said she spoke briefly Wednesday about the issue with U.S. Health and Human Services Secretary Sylvia Burwell at the Supreme Court. Castor said a report produced by the U.S. Centers for Medicare & Medicaid Services, or CMS,  says that the Florida Low Income Pool is outdated and in need of reform, “and we just don’t know at this point what this means monetarily.”

She added that CMS is also looking for hard data to ensure that if they partner with Florida in primary care that it’s proven to be effective, and that those funds “aren’t just going into a black hole of private managed care.”

Since 2005, Florida has had a Section 1115 Medicaid waiver establishing a low-income funding pool to aid the state’s hospitals. The state has received between $1 billion and $2 billion annually to support safety-net providers. But that’s at risk now with the feds saying they don’t intend to continue that waiver.

There has been speculation that the Obama administration would once again find a way to fund the Low Income Pool program if the state were to go ahead and agree to Medicaid expansion, which would provide health care insurance for about 1 million uninsured people in the state. Such a move is backed by a number of business groups in the state and even Florida Senate President Andy Gardiner, but the House remains obstinate and Scott has done nothing to push them.

“Isn’t that inconsistent?” Castor said during a conference call with Florida-based reporters Wednesday afternoon. She said that that Scott and other Republicans are demanding federal funding to help with health care, yet conversely they refuse to accept the federal plan on expanding Medicaid, where the federal government would pick up all of the costs for the first three years and 90 percent after that. “They need to be more consistent, more logical, and put the care of their neighbors and the health of our state ahead of those old ideological battles,” she said.

House Minority Leader Nancy Pelosi picked Castor to attend the oral arguments in the U.S. Supreme Court Wednesday on the closely scrutinized King v. Burwell case, in part because of her experience with drafting the Affordable Care Act and Florida’s position in leading the nation for the number of ACA sign-ups. The plaintiff asserts that the law forbids the federal government from providing tax subsidies for insurance purchases in the three dozen states (including Florida) that have not established their own insurance marketplaces.

The White House has been criticized for not offering a “Plan B” to deal with the millions of people with insurance through the Affordable Care Act who would lose their subsidies and ultimately their coverage if the court rules for the plaintiffs.

Castor said theoretically Congress could respond to that, but the fact that the House of Representatives has taken up unsuccessful attempts to repeal it nearly 60 times indicates that is not a viable solution.

Another option would be for Florida to create its own exchange for people to purchase health insurance. But as someone who was there for the drafting and discussions about the ACA, Castor said there was never any discussion that subsidies wouldn’t be provided for in a state that relied on the federal and not a state exchange.

“So I find it difficult to believe the Supreme Court will cherry pick five words and allow that to swallow all of the context, history and intent of the Affordable Care Act,” she said.