Mansion inflation deal scraps health insurance assistance for low-income people
- Congressional Democrats are preparing to start voting this weekend on an inflation deal.
- But the agreement does not expand health care coverage for people with incomes close to the poverty level.
- About 800,000 Florida residents will remain uninsured and the next shot at coverage may not be until 2024.
When Congressional Democrats announced last year that they were working on a massive spending bill to change America’s social safety net, health care advocates in Florida were optimistic that there might finally be a way to get medical coverage for more people.
But in the past week, their hopes were dashed. One of the many items that hit the cutting-room floor in the Democrats’ $740 billion settlement of the Inflation Reduction Act was a provision to evade Republican state lawmakers to expand Medicaid to nearly 800,000 Florida residents.
Health care advocates say the omission is a major blow to the uninsured in Florida, especially at a time when many are concerned about the recession, and residents are already facing steep costs at the grocery store and gas pump, as well as high rental bills.
“It’s definitely a missed opportunity, especially if the whole thing is focused on inflation and the effects of inflation,” Scott Darius, executive director of the nonprofit health group Florida Voices, told Insider.
Florida is among 12 Republican-led states to refuse to expand Medicaid under the Affordable Care Act, known as Obamacare. By law, states pay 10% of the costs while the federal government picks up 90% of the tab.
Florida is unlikely to have a chance to expand Medicaid until 2024 at the earliest. Florida health care advocates and Democrats don’t trust Republicans in the state legislature to change their stance against Medicaid expansion, so they hope to put the question on a ballot in the 2024 election to get voters to support outright.
“Having a ballot is our best chance of getting a Medicaid expansion passed,” Senator Shiffrin Jones, a Democratic senator for Miami Gardens and a member of the Senate Health Policy Committee, told Insider.
“This should be a top priority for us, but Republicans have shown us time and time again that they don’t care what makes sense,” Jones added. “They are interested in what feeds their base.”
In 2021, President Joe Biden’s $1.9 trillion coronavirus rescue package attempted to improve the Medicaid deal by taking on state costs for two years, but Florida has yet to do so. Republican Governor Ron. DeSantis’ office told the Washington Post in March 2021 that he “remains opposed to expanding Medicaid in Florida.”
The governor’s office and several other GOP leaders in the state legislature did not respond to Insider’s questions about whether any circumstances, such as a recession, could change their stance on Medicaid expansion.
Republicans have raised concerns about collecting more Medicare costs, citing concerns that the federal government may one day recover Medicaid payments.
House Speaker Chris Sprouls, a Palm Harbor Republican, said he believes Medicaid should only go toward the most vulnerable populations, rather than relying on income, he told the Orlando Sentinel in March 2021.
Under Obamacare, people who earn $13,590 or less per person or $27,750 for a family of four qualify to enroll in Medicaid. This raises objections from Republicans since it does not take into account disability or work status.
Reverend Vanessa Tinsley, executive director of Bridge to Hope, a Miami-based community organization whose services include a food program, said the narrative about people on Medicaid was not correct. Many of the clients you serve have college jobs and degrees.
“It’s not about working hard — we have this here — but they’re working hard in low-paying jobs,” she said, adding that although Florida has raised its minimum wage, it has not kept pace with rising rents. One major medical problem, she said, can evaporate or increase savings.
The US House version of Biden’s agenda cut the price by more than half
For more than a year, Democrats in Congress have explored ways to sidestep Republican lawmakers in Medicaid-rejecting states. An estimated 4 million people nationwide who are uninsured would be able to join Medicaid if all states expanded the program, according to a federal government report prepared by the Department of Health and Human Services.
The $2 trillion US House of Representatives Better Rebuilding Act in November 2021 came with a solution to fill the Medicaid gap. It would have paid the full cost of private health insurance premiums for people with incomes close to the poverty level.
But that ruling was among several that were stripped to create the Inflation Reduction Act, even though the bill retained other health care policies on drug pricing and private health insurance for high-income people who do not qualify for Medicaid.
The bill can still change. Democratic Senator Raphael Warnock plans to introduce an amendment to help people who do not have access to Medicaid. The amendment will be introduced during a “rama vote” session, an extended session of votes on the amendment that may end with changing the final draft of the legislation. The Senate is considering an inflation deal that begins on Saturday.
Florida Voices for Health is working with Southerners to expand Medicaid to advance Congress this week in support of the Warnock Amendment.
But conservative Democratic Senators Joe Manchin of West Virginia and Kirsten Sinema of Arizona have been wary about increasing the cost of the legislation. One estimate from the nonpartisan Congressional Budget Office found that the Medicaid idea of the Rebuilding Better Act could cost the federal government $125 billion.
We may have to be creative
Without a federal solution or an immediate suffrage vote, Medicaid’s fate is in the hands of state legislators or voters.
Tinsley of Bridge to Hope said she’s “terrified” of the recession because she’s already seeing people living on the edge. She knows families whose parents can’t marry because otherwise their children wouldn’t be eligible for Medicaid, people who skip needed medications, or asthmatic parents who can’t afford health insurance and are left to borrow their children’s inhalers.
“The people in my food line used to be both donors and volunteers,” Tinsley said. Our resources are shrinking.
She said that the unaffordability of health care was exacerbating people’s conditions. She added that many people across Florida who have to cut back on spending can only do so by lowering their grocery bills. Less expensive foods are often less healthy, which leads to problems like diabetes and high blood pressure which in turn increases people’s healthcare bills.
DeSantis is a candidate for re-election in Florida and is expected to win given that Florida Republicans have 220,000 registered Democrats in the state. Both Democrats running the nomination in the Aug. 23 primaries to face him — Rep. Charlie Crist and Florida Agriculture Commissioner Nikki Fried — support the Medicaid expansion.
Jones faces a primary opponent on August 23. If reelected, he plans to introduce a bill to expand Medicaid, he said. However, he said that on this round he wants to try to see if there is a way to strike a bipartisan deal as some other GOP-led states have done — especially after uniting hospitals and health insurance companies behind the effort.
“Maybe we should be creative,” he said.