Defend not Defund: Florida's House Proposal to Defund Planned Parenthood
Planned Parenthood has long been one of the state’s anchors with respect to the provision of health care and public health services to Floridians – particularly low-income and underserved women. Planned Parenthood currently operates 22 centers throughout the state and, in 2014, served nearly 70,000 Floridians. Nevertheless, a unique set of instructions tucked into the Florida House’s version of the state’s 2016-17 budget would prohibit Planned Parenthood from receiving any funds that pass through the state treasury. Although such a prohibition pertains to only a miniscule fraction of the state budget, it would nevertheless thwart longstanding state priorities, undermine the provision of critically needed services to underserved Floridians, cost Florida and Floridians far more than it would save, and likely prove to be an unlawful and wasteful effort.
Paid For, Never Redeemed: State Savings in Florida’s Medicaid Program Due to Floridians’ Lagging Incomes Are More Than Sufficient to Fund the Extension of Coverage to 800,000 Uninsured, Low-Income Adults
The governor and majority leadership in the Florida House have persistently but unfairly attacked Medicaid - the health coverage safety net - for purportedly swallowing the state budget. These claims have in turn been used repeatedly to justify rejection of proposals to extend health coverage to more than 800,000 uninsured Florida adults in or near poverty, despite the fact that the portion of the cost funded by already-paid federal tax dollars will never fall below 90 percent.
The fact is, not only has the percentage of and growth in state general revenue (discretionary) funding dedicated to Florida’s Medicaid program been continuously overstated by critics, the federal share of Medicaid costs paid has also been continuously increasing.
More specifically, under the current Medicaid program, increases in Florida’s Federal Medical Assistance Percentage (FMAP) will save Florida more than $2 billion state dollars over the 8-year period from 2011-12 through 2019-20. These savings far exceed the state’s share of the cost of Medicaid expansion. In other words, the expansion has already been fully funded. Furthermore, these increased FMAP rates are the result of Floridians’ incomes slipping relative to those of the U.S. as a whole, as that comparison is the basis for the FMAP calculation. Uninsured, low-income adults - those affected most by the factors that have generated the state savings - are also the ones who continue to suffer as a result of the legislature’s consistent refusal to reinvest those savings to provide coverage most will otherwise be unable to obtain
Return on Disinvestment: State’s Threadbare Mental Health System Exemplifies the Case Against Tax Cuts
In his proposed state budget for 2016-17, Florida Governor Rick Scott has called for another round of significant tax cuts, this time on the order of a billion dollars. He proposes these cuts at the expense of funding for essential state services that have the potential to improve the lives of countless Floridians as well as Florida’s fiscal and economic bottom lines. A prime example of an area where the Governor and Legislature have starved an essential service system to the breaking point is in the area of mental health.
An estimated one in six Floridians are experiencing mental illness, and as a group they are disproportionately likely to lack health coverage or even appropriate and timely access to services.1 In particular, only those facing severe and persistent mental illnesses can be served through Florida’s statefunded mental health system. Individuals with moderate or emerging behavioral health needs are ineligible to receive services, despite the fact that prevention and early intervention services can be provided at a small fraction of what would otherwise be the eventual cost to families, taxpayers and businesses.
Medicaid Managed Care, the Low Income Pool and Medicaid Expansion
Review of a timeline of actions taken by Florida’s legislative leadership and governors over the past decade on Medicaid reveals how state leaders have inconsistently and selectively used information to simultaneously embrace and undermine the program (and the flexibility/funding provided at the federal level).
More Low-Income Floridians Covered Through Medicaid: Context and Implications
Medicaid is the program providing health coverage for the lowest-income and most vulnerable Americans. Medicaid is administered and financed through a partnership between the federal and state governments. Eligibility for Medicaid is based on income, although different income limits apply to the different eligibility categories (children, parents and caregiver relatives, seniors and people with disabilities, and pregnant women).
Despite Florida’s strict eligibility rules, enrollment in Florida Medicaid continues to increase. In order to assess what these increases mean in terms of access to coverage as well as fiscal impact, they must be reviewed in context. The facts presented below shed light on the reality underlying the raw numbers.
First and foremost, increased Medicaid enrollment means that more extremely low-income, uninsured Floridians have health coverage they could not otherwise obtain. Beyond this, the increases coincide with the launch and increasing awareness of the federal Health Insurance Marketplace, the subsidies available through the Marketplace that make coverage affordable, and the “No Wrong Door” system that facilitates enrollment in the appropriate coverage program. These elements have outstripped other demographic and economic factors in terms of their impact on enrollment during the past two years, but should have a far less substantial effect going forward.
Model of Stability: Measured Growth in Both the Overall Medicaid Budget and of Managed Care Plan Payment Rates Will Constrain Costs of Medicaid Expansion
In the most recent round of debate by the Florida Legislature over whether or not to extend coverage to hundreds of thousands of the lowest-income Floridians though the Medicaid program (or an alternative that meets the requirements of the Affordable Care Act), opponents invoked many familiar and longdebunked arguments. Perhaps the oldest and most often cited of these claims is the assertion that the current Medicaid program is “spiraling out of control” and “swallowing the state budget.” These precise claims were invoked again as purportedly central to the House majority’s opposition to the Senate’s proposed coverage expansion by creating the Florida Health Insurance Affordability Exchange Program (FHIX) during the recent special session.
Problems Cited by State Leaders as Justification for Rejecting Health Expansion Are Either Problems of Their Own Making or Already Addressed
For the past several years, leadership in the Florida House of Representatives has repeatedly rejected the opportunity to extend health coverage to non-elderly, uninsured adults with family incomes up to 138 percent of the Federal Poverty Level through Medicaid or an alternative as provided under the Affordable Care Act (ACA). This would include, for example, a single parent of two children with annual income between $6,930 and $27,720, as well as a single adult with income below $16,240.
In attempting to justify its refusal, Florida House leaders in particular have ignored or selectively
interpreted almost every relevant fact pertaining to expansion and its implications for Florida. A review of those facts and implications are beyond the scope of this brief, but they include misrepresentations of the fiscal and economic impacts of expansion, the extent of available federal flexibility to deviate from traditional Medicaid rules, the nature of both the Medicaid program and the expansion population, and the effectiveness of the Medicaid program in providing health coverage, to name a few.
Health Care Expansion Requirements Could Limit Enrollment of Uninsured Floridians and Strain Low-Income Budgets
When the legislature convenes in special session June 1, it will consider various proposals to provide health-care coverage to Floridians in households earning less than 138 percent of the federal poverty level who are not eligible for Medicaid.1 Legislative analysts estimate that 800,000 uninsured Floridians could gain health-care coverage under such proposals. 2 But policymakers, in designing their new plan, should consider two facts: (1) work requirements will be difficult or impossible to meet for many intended enrollees; and (2) for workers at or below the poverty level, even modest premium payments and co-pays would further strain already tight household budgets.