Republican Florida Legislature discusses, but shoots down, Medicaid expansion

The Republican-controlled Florida Senate Friday voted down an effort to prod the state into finally expanding Medicaid to low-income, childless adults, as allowable under the Affordable Care Act, often referred to as Obamacare.

The Senate once embraced the concept of expanding the safety net health care program to cover low-income workers but that effort — which occurred in 2015, when Rick Scott was governor — ultimately came up short.

And so did Senate Democratic Leader Lori Berman’s efforts on Friday to amend SB 1758, sponsored by powerful Republican Sen. Don Gaetz. The bill would update Florida’s Medicaid and food assistance laws to better align with President Donald Trump’s signature One Big, Beautiful Bill Act.

SB 1758 goes beyond the OBBA by proposing to impose work requirements on about 1,100 low-income Medicaid enrollees. Federal law only imposes work requirements on low-income childless adults who qualify because of the Medicaid expansion, which Florida has not done.

Berman’s amendment would have tied implementation of the controversial new work requirements to a Medicaid expansion.

“This is actually a five-sentence amendment, but it’s an extremely impactful, important amendment. It says that the state of Florida will not put the work and community engagement requirements in place until we have expanded Medicaid eligibility, and the expansion has been approved by the Centers for Medicaid and Medicare and Medicaid Services,” Berman said, referring to the federal agency that helps fund the safety net program.

“So, we are simply aligning our laws so that we could comply with the One Big, Beautiful Bill requirement and expand Medicaid here in the state of Florida,” she said.

Berman said traditional Medicaid recipients, the poor, elderly and disabled, were specifically exempt from the work mandate because Congress “understand[s] that it will cause too many people to fall within a gap.”

She referred to the coverage gap, a term used to describe when people earn too much to qualify for traditional Medicaid, but too little to qualify for health insurance subsidies made available in the ACA marketplace or exchange.

Berman’s efforts were supported by other Senate Democrats, who said expanding Medicaid would provide an additional 1 million people with access to health care coverage.

And because the federal government contributes an enhanced matching rate for Obamacare enrollees, expanding Medicaid to low-income adults would bring an additional $4 billion in federal Medicaid dollars, the Democrats said.

“Why wouldn’t we want Floridians to be healthier? Expanding Medicaid in Florida would provide health coverage to approximately 1 million people,” said Sen. LaVon Bracy Davis. “Why don’t we want Floridians to be healthier? Why are we leaving money on the table?”

But Gaetz, who supported a Medicaid expansion when he was in the Florida Senate in 2015, told Berman: “This is an old debate. It’s about 10 or 12 years old. The Legislature has time and again considered whether or not we want, as Sen. Bracy Davis has said, to add a million more people to the Medicaid rolls paid for by the taxpayer,” Gaetz said.

He continued: “Adopting a Medicaid expansion would make Florida increasingly dependent on the federal government and vulnerable when the federal government eventually lowers the enhanced rate for the expansion population, which we know they will do.”

The amendment ultimately was shot down on a voice vote.

Florida is just one of 10 states that has not expanded Medicaid access to low-income childless adults, a key component of the ACA. The federal law allows states to expand Medicaid eligibility to people earning up to 138% of the federal poverty level, which is about $22,000 annually for an individual and $45,500 annually for a family of four.

The House briefly discussed a Medicaid expansion this week when deliberating on HB 693, the companion measure to SB 1758. While the bills address similar topics they have substantive differences.

“No urgency”

Offered by Orlando Democrat Rep. Anna Eskamani, the amendment would have prevented the House bill from taking effect until the expansion of Medicaid to “close the coverage gap.”

Debate over Medicaid expansion in the Republican-controlled Legislature has been volatile.

Gov. Scott and then-House Speaker Steve Crisafulli opposed expanding Medicaid while then-Senate President Andy Gardiner pushed for expansion.

Unable to reach an agreement with Gardiner, who had tied the Medicaid expansion to budget negotiations, Crisafulli abruptly adjourned the House three days before the end of the regularly schedule session, a move the Florida Supreme Court ruled was unconstitutional.

It’s the last time the Florida Legislature gave serious consideration to expanding the program.

“And unfortunately, this issue has just not come to fruition. There’s also just been no urgency about it. I’m shocked that we don’t talk about it anymore. It’s as if it doesn’t exist, and yet, red and blue states have made this decision to pass Medicaid expansion,” Eskamani said, adding that she filed the amendment to force the discussion.

“I think it’s important to have that conversation. And yes, it would delay implementing what is federal law, but I hope it also expedites your efforts to get it done, so that we are not only complying with federal law, but that we’re also meeting the need of Floridians who are looking towards us to solve the basic issue of health care access.”

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