When newly-elected state Rep. Allison Tant began to prepare for Florida’s 2021 legislative session, she spotted a big hole in the state’s health care budget.
Florida’s unemployment rate is more than double what it was a year ago, according to the Bureau of Labor Statistics, which has led to nearly 700,000 people signing up for Medicaid, the federal-state health care insurance plan that pays for the treatment of low-income patients.
That will increase the state’s cost to participate by about $1.2 billion for the 2021-22 budget year, according to state economists.
“We’re going to have to figure out how to pay for that,” said Tant, D-Tallahassee, who was named to the House Health and Human Services Committee. “The number of people now qualified for Medicaid is going to put a very stringent burden on us.”
Most of the state’s general revenue comes from sales tax collections, which are down due to coronavirus restrictions and people’s reluctance to travel.
Economists expect it will take until 2023 to recover most of the coronavirus-caused job loss, and up to a decade for the travel and leisure industry to fully rebound.
That means most of the 695,680 people who have signed up for Medicaid since March, according to the Agency for Health Care Administration, will likely remain on the rolls for quite a while.
Tant wants a long-term plan to deal with coronavirus consequences: “My goal is to keep our hospitals as financially secure as possible so they can continue to provide the critical services we are going to need, but we also have mental health, substance abuse and multiple of multiples of (health) care impacted across the system.”
With more than 2 million Floridians lacking health insurance, according to a Georgetown University report, the crisis has taxed Florida’s hospitals, with unexpected expenses.
A Florida Hospital Association (survey of its 214 members found between March and January the coronavirus bill to the industry is at least $3 billion.
Mary Mayhew, the group’s CEO, said the calculation includes expenses such as overtime for staff, additional equipment and supplies, plus the loss of revenue due to restrictions on elective surgery and people fearful of seeking care.
“And even with federal relief fund through the CARES Act, that still leaves a revenue shortfall of over $2 billion,” Mayhew said. With Medicaid, Washington picks up about 61% of the cost, with Florida paying the rest.
State economists said earlier this month that Florida was on track to spend $31.6 billion on Medicaid in this budget year that ends in June. That’s a 19% increase above last year.
Since April, Medicaid enrollment has increased on average by 86,960 people a month.
Subtract federal coronavirus relief programs and the new enrollees add an additional $1 billion in Medicaid costs to Florida for the remainder of this budget and another billion dollars projected for the next one.
“That’s going to blow a big hole in our budget. We’re going to have to figure out a way to pay for it,” Tant said.
Just how effective Tant, the former chair of the Florida Democratic Party, can be as a minority member of the committee remains to be seen.
Multiple requests for comments to members of the chamber’s Republican leadership have gone unheeded over the last two weeks.
The Health and Human Services Committee is led by Rep. Colleen Burton, R-Lakeland. A conservative standard bearer, Burton is past chair of the Health Quality Subcommittee and has focused on programs for newborns and young children and has sponsored bills to restrict abortion rights. She declined to respond.
Rep. Jay Trumbull, R-Panama City, chairs the House Appropriations committee but did not respond to questions about how he plans to bridge the gap.
Mayhew said the FHA is particularly concerned about any cut to Medicaid reimbursements to hospitals as a way to balance the state budget.
Sen. Shevrin Jones, D-West Park, and Rep. Nicholas Duran, D-Miami, want to bridge the budget shortfall by expanding Medicaid, an idea that has been raised by Democrats in recent years and always shot down by the controlling GOP majority.
They say if lawmakers act on their proposal (SB 698, HB 341) the state would draw down an additional $14.3 billion through 2024.
“Drawing down new federal Medicaid funds will be one of the fastest, proven-effective ways to deliver fiscal relief to Florida’s economy during this economic downturn,” Duran said.
The proposal would expand coverage to an estimated 850,000 residents, and the way Jones and Duran calculate the workings of the Medicaid program, would also reduce the state’s current Medicaid expenses by as much as $77 million annually.
“Rather than cutting critical services in the midst of a public health crisis, we must make smart investments in our people because it’s the fiscally, and morally, responsible thing to do,” Jones said.
The FHA has supported Medicaid expansion in the past: “One way to help offset the state’s revenue shortfall is to draw down more Medicaid dollars,” Mayhew said.
But the group has yet to do a detailed analysis about expansion under the current circumstances.
“We have to work on what is the state options for addressing the shortfall that is driven by those who are today eligible for the program and on the program,” Mayhew added, that “is different from opening up the program to more individuals.”
Rep. Ramon Alexander, D-Tallahassee, is the senior member of Leon County’s delegation to the House and now sits on the Appropriations Committee, where lawmakers will write the state budget.
He said the coronavirus has exposed the lack of access to health care throughout Florida, including rural and urban areas.
Alexander thinks once lawmakers start to discuss the numbers in budget talks, the issue of Medicaid expansion under the Affordable Care Act will be the proverbial elephant in the room.
The Republican-controlled Legislature has rejected proposals to expand Medicaid twice since 2012. A 2015 plan was approved by the Senate but the House unexpectedly adjourned the session and left town before the Senate bill was introduced.
Under Obamacare, the federal government would pick up 90 percent of the cost.
A report by the Commonwealth Fund projects expansion would provide Florida an additional $14.3 billion in Medicaid money over the next five years, at a cost to the state of $516 million.
Those costs would be offset by moving current Medicaid clients into the new program, reducing the state’s match from 39% to 10%.
“I think when decision makers get past ideology, when (they) get to the reality of what people are facing every single day, I think we will have movement,” Alexander said.
Medicaid expansion is no longer a partisan issue, he added: “This speaks to the purpose of government, to be focused on the health and well being of the people.”
Committee meetings to prepare for the 2021 session of the Florida Legislature, which begins March 2, continue starting Monday.
– Courtesy Tallahassee Democrat