A ‘Nixon goes to China’ moment? Conservative Republican pushes for state Medicaid expansion.

Three days is long enough for Joel Rudman. Image via Colin Hackley/Florida Politics.

A conservative Florida Republican doctor who has been an ally of Gov. Ron DeSantis and his handling of COVID-19 says it’s time for the state to expand Medicaid despite the long-running opposition of GOP legislators.

Rep. Joel Rudman recently completed what he called his health care listening tour where he held meetings in the Panhandle, Central Florida and South Florida. He heard from patients, constituents and hospital representatives, all of whom were bemoaning Florida’s broken health care delivery system.

He said three themes emerged: high levels of uncompensated care, low Medicaid reimbursement rates and a workforce shortage.

Rudman said the loss of Medicaid coverage for hundreds of thousands of Floridians this year illustrates the need for change. A spreadsheet compiled by House Democrats shows of the 524,076 Floridians who have lost coverage in the last four months, nearly 50% are under the age of 21.

While people have lost their Medicaid coverage, Rudman says, they aren’t losing access to health care.

“It’s not that these people are dying on the street, it’s that they’re costing us more money by showing up in the emergency room because they do not have access to a primary care physician. They do not have access to Nemours (Children’s Hospital). They do not have access to specialty care,” Rudman said.

“And so, when we talk about things like Medicaid expansion, and when we talk about caring for our children, in the long run, it really is cost savings. That’s the argument I need to make with my fellow colleagues.”

Rudman said the Legislature took “baby steps” last Session when it passed HB 121, which expanded income eligibility for the Florida KidCare program. That’s the name of the federal children’s health insurance program and, like Obamacare, it’s an optional Medicaid expansion. 

HB 121 was championed by House Speaker Paul Renner who worked closely with Rep. Robin Bartleman on the legislation.

Expanding Medicaid to uninsured childless adults, Rudman said, isn’t much different.

“These are not handouts. We’re not giving insurance to people who don’t deserve it or people who aren’t willing to work,” Rudman said.

“We are talking about the working poor. We’re talking about that single mom who’s holding down two jobs but neither job gives her health insurance. She can’t afford it herself. She needs help. These are not giveaways. These are not handouts. We’re not throwing money down the drain. We are helping our working-class Americans get ahead. And I definitely think it’s a problem worth solving.”

Rudman said he isn’t worried about a backlash or a potential challenger in a Republican Primary, saying he is one of the most conservative Republicans in the Legislature.

“They said only (Richard) Nixon could open China. Maybe it will take a die-hard Conservative from Florida’s third district to expand Medicaid,” he said.

Rudman’s legislative history punctuates his point. He helped push legislation (SB 1580) across the finish line. That measure allowed health care providers to turn patients away based on conscience-based objections. 

Florida Democrats have repeated a message for the last year that “every Florida deserves the freedom to be healthy, prosperous and safe.” According to House Democratic Leader Fentrice Driskell, that includes expanding Medicaid access to uninsured, childless adults as allowable under the federal health care law, often referred to as “Obamacare.”

To date, 41 states (including Washington, D.C.) have adopted the Medicaid expansion and 10 states have not adopted the expansion.

A new U.S. Census Bureau report estimated that 11.2% of Floridians were uninsured in 2022. While that’s a decrease from 12.1% being uninsured in 2021, Florida’s uninsured rate is still one of the highest in the nation and is higher than the national rate of 8%.

When asked about the state’s high uninsured rate during the second Republican presidential debate, Gov. DeSantis defended the state’s Medicaid policies, saying, “we’re not going to be like California and have a massive number of people on government programs without work requirements.” 

“What I have seen over the years is the politicization of this issue that should just really be about common sense and what’s good for Floridians,” Driskell said. “So, while it was a surprise, of course, to hear about Rep. Rudman and hear that he supports Medicaid expansion … I was just really glad, frankly, to hear someone across the aisle willing to talk about this in a non-politically charged common sense way.”

The Medicaid expansion is a pivotal portion of the Affordable Care Act. The federal law initially required states to expand Medicaid to low-income childless adults or lose access to federal Medicaid funds.

But in National Federation of Independent Business v Sebelius, the Supreme Court of the United States held in 2012 that while the law was constitutional, states couldn’t be required to expand Medicaid.

Most states have expanded Medicaid to childless adults earning up to 138% of the federal poverty level. Some residents in non-expansion states, such as Florida, continue to have difficulties obtaining health insurance coverage because they don’t earn enough money to qualify for the subsidies that are offered under another part of Obamacare.

Rudman would prefer that the discussion not be tied to the sweeping federal law.

“When I hear my fellow constituents, when I hear patients, when I hear hospitals, crying and sounding the death knell for what’s happening to our health care system in Florida, I think there’s a solution out there,” he said.

“I think we should be talking about the potential solution. As far as the politics of the situation, whatever name you need to slap on it. Hey, we can call it by a different name,” he added. “How about we call it Rudmancare?”