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Medicaid expansion not likely, legislative leaders say

Barring a major shift among Republicans it remains unlikely that Florida will move ahead with an expansion of Medicaid, a key component of Obamacare.

Florida Gov. Rick Scott two years ago did a turnabout and came out in support of a limited Medicaid expansion for the working poor so long as the federal government paid 100 percent of the tab.

But Scott’s tepid support of expansion was beat back by staunch opposition from House Republicans, including then-Speaker Will Weatherford, doomed the effort.

Scott on the campaign stump this summer reiterated his support for Medicaid expansion but not enthusiastically. And  while there’s a new leader in the House of Representatives, he sounded skeptical on Tuesday that the state would expand Medicaid any time soon.

“We’ll wait and see what the federal government does, but we believe we stand firm with where we are right now, and that’s without expansion,”  House Speaker Steve Crisafulli, R-Merritt Island, told reporters shortly after he was sworn into his new post.

Senate President Andy Gardiner, R-Orlando, also sounded doubtful, noting that attempts to broker a deal between the federal government and the state over an alternative to a traditional expansion of Medicaid has not been successful.

“The federal government has given us absolutely no flexibility at all,” Gardiner said.”It’s either all or  nothing.”

Florida is one of 23 Republican led states that did not expand Medicaid following the Supreme Court of the United States ruling in 2012 that made the expansion optional.

The expansion would provide people with incomes up to 138 percent of the federal poverty level–or $32,913 for a family of four–with access to health care. This group of people earn too much money to qualify for Medicaid as it is currently structured, but not enough money to qualify for the subsidies available in the insurance exchanges.

Just under 1 million Floridians enrolled in the federal exchange early estimates released by the federal government in spring showed. Because Florida did not establish its own exchange residents wanting to tap into the subsidies were forced to enroll in the federal exchange.

The Office of Insurance Regulation in the summer said estimated the number of Floridians who used the exchange was 762,723. Those figures come from a review of rate filing submitted from companies.

Gardiner also told reporters that the Senate would be “open to debate” about having Florida set up its own health, exchange, although he said the state may want to see what happens in a lawsuit involving subsidies for those enrolled in federally run exchanges. The Supreme Court of the United States has said it will review a lawsuit that challenges the legality of subsidies for people enrolled in a federal exchange.

Health care providers, including the state’s large public hospitals, remain strongly in favor of expansion and the $50 billion over a ten year period that would come into the state.

Democratic leaders also remain firmly in favor of expansion. House Minority Leader Mark Pafford, D-West Palm Beach, said he was going to push for a “free and open vote” on Medicaid expansion in the Florida House. Pafford said there was “whipping” that occurred the House two years ago when a Republican health care proposal crafted by Sen. Joe Negron,R-Stuart was defeated in the House.

“All we want is a free and open vote.I have no doubt there are great Republicans in this chamber, there are great Democrats in this chamber who could pass Medicaid. I’d love to see that for an open vote. Health care affects everybody that’s alive at some point in their life.” Pafford said.  “This is something if we don’t address, people are dying.”

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