Most Floridians don’t understand why so many in our state are uninsured, or why our health disparities are among the worst in the country, or what can be done.
Everyone who cares about these questions — and about improving health outcomes and lowering costs —needs to appreciate the state Legislature’s tremendously powerful role. It’s a fundamental civics lesson. Equally important is understanding the history of what’s transpired in the Legislature during the past eight years as Florida has refused federal funding to cover uninsured residents.
Everyone should know the position of their state representative and senator on Medicaid expansion. But when lawmakers don’t even allow for debate, recording history can be challenging. The Miami Herald’s June 13 editorial, “Poor, uninsured? Republicans don’t care,” provided vital historical facts. It quoted Florida’s House speaker and Senate president explaining why, even while we were in the midst of a deadly pandemic, they would not allow Medicaid expansion to be considered during the 2021 session.
A quick review: The Affordable Care Act required states to cover low-income uninsured adults through Medicaid. While states pay 40%-50% of regular Medicaid program costs (with the federal government paying the rest), states pay no more than 10% of the costs for this expanded coverage group. Tragically, in 2012, the Supreme Court ruled that the ACA’s Medicaid expansion provision must be a state “option” rather than a “requirement.” Florida is one of only 12 states opting not to cover our fellow Floridians. In short, funds dedicated to insuring our most vulnerable neighbors are languishing in Washington — readily available, but refused by the Legislature.
There’s a mountain of undisputed evidence that expanding Medicaid improves health outcomes, lowers disparities, improves family financial stability, boosts local economies and results in state budget savings. Under the recently-passed American Rescue Plan, the federal government offered a deal that seemed too good to turn down. In exchange for expanding Medicaid, Florida would receive additional federal dollars amounting to a net budget windfall of more than $1.8 billion.
Still, Florida and a handful of other state legislatures have refused to expand Medicaid. Thursday, however, the Missouri Supreme Court unanimously ruled in favor of implementing a voter-approved Medicaid expansion plan, which the state’s Republican lawmakers and governor tried to block.
In light of the U.S. Supreme Court’s recent decision upholding the ACA once again, it’s reasonable to predict that, over time, every state will eventually expand Medicaid. As we wait and work and hope for that to happen, the facts underpinning Florida’s shameful health-justice history will be recorded: how many tens of billions of our federal tax dollars were lost forever; how many millions of Floridians suffered and died unnecessarily.
When will Floridians understand Tallahassee’s role in the state’s failure to expand Medicaid and hold state elected officials accountable for these incomprehensible losses?
While our grim accounting continues, congressional leaders are trying to halt the horrific health injustice in Florida and other states with the recently introduced Medicaid Saves Lives Act.
COVID-19 made clear that we cannot have racial justice without health justice, or health justice without racial justice. Notably, most of the non-expansion states are former slave states, and the majority of those harmed by our state’s opting out of Medicaid expansion are people of color.
More than 150 years ago, Congress passed the 13th Amendment abolishing slavery. Hopefully, Congress will again save us from “our own worst selves” by remedying the unconscionable injustice of denying healthcare coverage to some of our most vulnerable and marginalized residents — sooner rather than later.
Miriam Harmatz is advocacy director and founder of the Florida Health Justice Project.