Republicans want to limit Medicaid, kill Obamacare … and hurt people like me | Alan Chin | Comment is free | The Guardian
Governor Rick Scott of Florida announced on 16 April that he is going to sue the Obama administration for trying to expand Medicaid in his state, despite up to 800,000 people being potentially eligible. Florida is behind only Texas leading the nation in the number of uninsured. In both states, without either voluntary state-run health insurance exchanges or proposed Medicaid expansion, the Affordable Care Act has failed to make enough of an impact. Where you live now determines how you will or won’t get health care, every bit as much or more as your profession and income. [emphasis added]
Sadly, there are far too many elected representatives that feel a significant number of their impoverished constituents are disposable, while simultaneously holding the conviction that its impossible to coddle wealthy corporations enough.
From: Susan Chandler
Date: April 22, 2015 8:03:50 PM EDT
To: “Burgess, Danny” <Danny.Burgess@myfloridahouse.gov>
Subject: Re: Medicaid Expansion
Dear Representative Burgess,
While I do appreciate your having responded to my request that Florida implement Medicaid Expansion, I cannot appreciate the content of your response. It is misleading, to say the least.
You could easily fund Medicaid Expansion by: 1) closing the DROP pension loophole that now has Florida Department of Corrections Secretary Julie Jones newly overfeeding at the trough; 2) transferring mentally ill prisoners that don’t belong in prison to treatment facilities, where care will be less expensive and where they won’t be murdered; 3) setting up a state bank – like North Dakota’s approximately @100-year-old institution – to loan money and collect interest and keep lobbyists out of the financial loop as regards state pensions and more; 4) collecting all the ethics fines levied against legislators that shouldn’t have been written off; 5) ceasing to give tax cuts to businesses that pay low wages and offer no benefits, which keep Floridians dependent on the state and federal government; 6) restoring and streamlining Charlie Crist’s felon rights restoration protest, which cost a fraction of the New Jim Crow restoration process that makes it nearly impossible for a non-violent, first time offender to ever vote again; 7) having malicious public servants directly foot the bill for damages for wrongful convictions, wrongful deaths, injuries via excessive use of force, etc.; that they have caused via asset forfeiture and voiding their pensions.
There is much more you can do, of course; it boggles my mind and chills my soul that you would pretend otherwise while Floridians like young Charlene Dill die from lack of medical care.
Again, thank you for responding.
On Apr 22, 15, at 3:22 PM, Burgess, Danny wrote:
Thank you for contacting my office regarding the expansion of Medicaid. I appreciate you taking the time to contact me on this very important issue. While I understand and fully respect your position on this issue, I would like to take a moment to personally clarify why I believe this would be bad policy for the State of Florida.
Before I explain my reasons for opposing the expansion of Medicaid, I would like to make one thing very clear; I do not want to see any person go without health insurance. It is heartbreaking to think that there are people within this country who have to make a decision on whether or not to go to see a doctor over finances. On this we can all agree and many hours of research and prayer have gone into my decision. I cannot in good conscience obligate money we do not have. The issue is not a matter of whether or not I want to provide expanded healthcare, but whether or not we can afford it.
At first glance it sounds great to hear that the federal government is going to fund this expansion. However, when looking at the federal government’s specific offer, which I detail below, it becomes clear that they are not offering the State anything but unsustainable debt. Florida law mandates that the Legislature pass a balanced budget for our state just like everyone must balance a budget at home.
Under federal law, the current cost for Medicaid is split between the state and federal government. The State of Florida pays for 40% of the cost and the federal government pays for 60%. The rules of this agreement mean that the State of Florida cannot change or reform Medicaid without the approval of the federal government. If Florida found a way to make our Medicaid program better and the federal government refused to listen to our idea, then Florida will not be able to reform the program.
The federal government is not just a restrictive partner; they can also be quite punitive and very unreliable. The federal government is nearly $20 trillion in debt, which means that every dollar given is borrowed money that the federal government does not have. A perfect instance of this is with regards to federal flood insurance. In 2013, the National Flood Insurance Program came very close to running out of money as Congress and the White House wrangled over funding. We saw the federal government shut down in 2013 as they could not agree on a budget. As for their punitive nature, we only need to look at what they are doing with the Low-Income Pool (LIP) funding for hospitals. For the first time, the federal government has officially tied the ongoing negotiations over the continuation of LIP funding to expanding Medicaid under the Affordable Care Act. This decision by the federal government will leave Florida on the hook for over $1 billion.
In the US Supreme Court’s ruling in NFIB v. Sebelius, the Court said that the decision to expand Medicaid should be left to the states and warned the federal government against coercing states into expansion. The federal government is attempting to illegally coerce our state into expanding Medicaid in exchange for dollars to help hospitals provide health services to our most vulnerable citizens. Florida is one of the only states where the federal government is deliberately tying LIP funding to Medicaid expansion. With such an erratic and unreliable partner, I have very deep reservations about trusting the federal government to keep their word on funding this program.
Even if the federal government does keep their word on paying for the expansion under the current offer, after three years their contribution begins to decrease, and by year seven the State will be on the hook for paying 10% of the expansion. The State had our Revenue Estimating Conference run the numbers on Medicaid expansion and they determined that the cost of Medicaid expansion to the State just for those seven years will be between $3.4-$3.8 billion. That is more than three times this year’s budget surplus. Just like I would never obligate my family’s personal budget to something we do not have the money for; I cannot in good conscience obligate taxpayer dollars to something that the State of Florida cannot afford.
No Congress can bind another Congress, so it is very possible to imagine a scenario down the road where the federal government decides that the expansion of Medicaid should be funded with the same percentages as normal Medicaid, with a 60-40 split. If it costs the State $3.8 billion at just 10%, the cost to the State for an extra 30% would be unsustainable without either drastic spending cuts to other programs, such as education, or very large tax increases.
If Florida did expand Medicaid as currently proposed, the quality of care for recipients will be reduced even further and recipients will still be forced to go to the ER for routine medical treatment, much like the majority of them currently do without health insurance. This is because approximately 40% of doctors and a large number of specialists do not accept Medicaid patients due to the low rate of reimbursement that these doctors receive, according to a 2008 Center for Studying Health Systems Change national survey. The program must be fixed before it is expanded. By simply expanding Medicaid, quality of care will decrease and the waiting list will only grow longer, inhibiting all Medicaid recipients from receiving the quality care they deserve.
Any approach we would take should offer free market solutions that provide better health outcomes and more access to quality care for our most vulnerable citizens.
Our federal system of government has created 50 laboratories of democracy; we do not need to speculate about what ifs, we merely have to look at what has already come to pass. For example, in an April 15, 2015, article written by Arkansas State Senator Bryan King, he warns against repeating Arkansas’ failed attempt to expand Medicaid, which is very similar to the Florida Senate’s current proposal for expansion. Senator King explained:
“In 2013, Arkansas’s then-Governor Mike Beebe (D) pushed a non-traditional Medicaid expansion program that gives low-income individuals subsidies to use toward private coverage, rather than enrolling them into Medicaid. This initiative was marketed as a “state-based” plan for reform and one that inserts flexibility and innovation into expansion as outlined under the Affordable Care Act (ACA). While nearly all Republican governors took a firm stand against traditional expansion, some now perceive Arkansas’s model as a means to get their hands on federal money while distancing themselves from the ACA. Unfortunately, as Arkansas can now attest, Medicaid expansion remains a bad deal for states and cannot truthfully be sold as a fiscally prudent or free market idea. When you get beyond the rhetoric, Arkansas’s expansion has been a disaster.”
Ever wonder why the majority of lobbyists and special interest groups support Medicaid expansion? This is because big business and the big hospitals stand to make huge profits from the expansion of Medicaid due to the fact that many primary care doctors and specialists do not accept new Medicaid patients and are therefore forced to present themselves to emergency rooms. Those of us who oppose Medicaid expansion but want to reform a broken system are not in the pockets of the special interests; we are standing up for those in need of quality health insurance. We are fighting to prevent a broken program from expanding because as it currently exists, it is failing to help the very people it was designed to assist.
I was elected to vote in the best interest of my constituents and all residents of the State of Florida. I want to be very clear, this decision is mine. Before I was elected to this position, I was very vocal about my stance and it has not changed. I do not toe party lines or cast votes for political expediency; I have already voted against my own party in my short tenure as an elected representative. My decision also has nothing to do with our President or his policies as some have suggested. My decision is about the people of Florida and what is in their best interest – to ensure we continue to have a sound budget and never obligate ourselves to something we cannot afford. Every vote I cast is prayerfully made and reflects what I believe is in the best interest of those that I was elected to represent. I will never become the status quo nor will I ever violate my conscience or convictions so long as I have the honor to serve in this capacity.
Thank you again for your email and please do not hesitate to contact me in the future. It is an honor to serve you in the Florida House.
State Representative, District 38
35358 State Road 54
Zephyrhills, Florida 33541
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