2016-17 HHS Budget Is Best Viewed As a Series of Missed Opportunities

Unlike last year, the 2016 regular session of the Florida Legislature adjourned on time, with House and Senate agreeing on a budget for the upcoming year.

In 2015, the disagreement over whether or not to accept what would have been a 100 percent federally funded extension of health coverage to as many as 800,000 uninsured, very low-income Floridians pushed the 2015 session into overtime.  This year, however, Medicaid expansion and its potential benefit to Florida's businesses, families and taxpayers were barely discussed. Instead, House and Senate entered the budget negotiation process with similar proposals and the intent to avoid another impasse.

The result, the 2016–17 General Appropriations Act, includes some small but important efforts to address Floridians' unmet health care and human services (HHS) needs.  In the larger picture, however, the 2016–17 HHS budget is best viewed as a series of missed opportunities that will create additional unmet need, particularly given the record amount of available general revenue.

> Read the report.

Uncovering Coverage Opportunities In Health Insurance Marketplace

Beginning October 1, 2013, millions of Floridians who are uninsured - or who are insured but have inadequate or unaffordable coverage - will be able to purchase a health plan through the new Health Insurance Marketplace established by the federal Patient Protection and Affordable Care Act (ACA).

Although a number of details remain unclear about Florida's Marketplace and the specific plan offerings to be made available to consumers there, the bottom line is that many more Floridians will be able to get and keep quality, affordable health insurance coverage than ever before.

> Read the report.

Comparison of Alternatives for Medicaid Expansion

With only two weeks left in the 2013 regular session, the question of whether the Florida Legislature will extend meaningful, affordable health coverage to more than a million very low-income, uninsured Floridians remains unanswered.

What the majority in both the House and Senate have made clear is that they have no plans to support a straightforward expansion of the current Medicaid program. As a result, three different alternatives to "Medicaid expansion" are presently working their way through the legislative process.

However, only one of the three proposals would allow significant numbers of Floridians below the poverty level to get and keep real coverage that would provide sustained access to essential care. That same proposal is also the only one of the three that would enable Florida to draw down up to $51 billion in federal matching funds over the next ten years, rather than allowing taxpayer funding earmarked for Florida to be diverted to benefit other states.

This brief compares the three proposals and their implications for the two key groups of stakeholders affected by the decision: low-income, uninsured Floridians and Florida taxpayers generally.

> Read the report.

Rejection of Medicaid Expansion Would Prove Costly to Businesses

Many of the businesses that anchor the state's service-based, tourist-dependent economy would be placed at a significant competitive disadvantage if Florida rejects Medicaid expansion.

These include, for example, Florida's retail, restaurant and hotel chains.

If Florida expands Medicaid, employers pay no penalty for low-wage workers who enroll in Medicaid.

As a result, a large employer that does not provide meaningful, affordable coverage to its eligible low-wage employees will save $3,000 for each such employee that enrolls in Medicaid instead of using Premium Tax Credits in the Exchange—but only if Florida elects to expand Medicaid.

> Read the report.

Governor's Budget Avoids Gutting Safety Net But Misses Opportunity to Strengthen State

Governor Rick Scott’s proposed 2013–14 budget looks much different than his recommendation of a year ago, when he proposed more than $2 billion in cuts to health and human services (HHS) programs.

This year, the governor’s budget calls for more than a billion dollar increase in the HHS portion of the budget.

The governor’s 2013–14 budget proposal has some serious shortcomings, however.  Of perhaps greatest significance is what is not included, namely any indication of an intent to expand the Medicaid program to cover almost a million uninsured Florida adults under the Affordable Care Act.

> Read the report.

Filling the Coverage Gap for Legal Immigrant Children Remains Appropriate

In 2009, Congress gave states the option to allow legal immigrant children to qualify for Medicaid and the Children's Health Insurance Program (CHIP) without enduring the five-year waiting period that applies to most public assistance programs for immigrants.

During the 2012 regular session, state legislation (SB 1294) was proposed that would have exercised that option in Florida and allowed such children to qualify for coverage through Florida KidCare (which includes children's Medicaid and CHIP). SB 1294 passed unanimously out of its first committee but did not make it to final passage. This legislation (or a closely related proposal) is expected to be considered again during the 2013 session.

State money is available to fund health coverage for legal immigrant children. Investment in coverage of these otherwise uninsured children will draw down an additional $43.1 million in federal funds.

> Read the report.

Political Rhetoric Drives Up Estimates of Medicaid Expansion Cost

The primary claim of those opposed to Medicaid expansion under the Affordable Care Act is that the cost to the state would be prohibitive.

One estimate—produced last month by Florida's Agency for Health Care Administration ($2.1 billion per year)—is three times higher than its own estimate from earlier in the year and four times higher than any of the other estimates. For reasons explained in this brief, that estimate must be dismissed outright. Other state-generated estimates ($741 million, $482 million) are less unreasonable, but still deliberately incorporate assumptions that significantly inflate the cost.

In fact, Medicaid expansion would increase the state's share of the total Medicaid budget by only 2 percent over the 10-year period. After factoring in the savings to the state associated with reductions in uncompensated care, the net (true) cost to the state may very well be negative. Thus, despite efforts to make the burden of Medicaid expansion seem onerous and unsustainable, in fact the opposite is true.

> Read the report.

Florida Employers Will Benefit Greatly From Medicaid Expansion

Affordable Care Act opponents have expressed a desire to forgo the opportunity to expand Medicaid, ostensibly out of concern for the perceived burden on the state budget and, by extension, on Florida businesses.

In reality, however, Florida's participation in Medicaid expansion would provide a significant and disproportionate benefit to employers in Florida's service industry-dominated economy.

> Read the report.

Amendment 3 Would Cut Funds for Schools, Health Care, Roads and Other Services

“Funding for Florida schools, universities, roads and bridges, health programs for children and the elderly, public transit, and a wide range of other public services will fall significantly if voters enact Amendment 3 on Florida's November statewide ballot.

“This constitutional amendment would severely limit the amount of state revenue that the state can spend on services, using a formula that led to drastic cuts in public services in Colorado - the only state to have tried it.”

The Center on Budget and Policy Priorities analyzes the effects on Florida and its quality of life if Amendment 3 passes on November 6.

“In short, adoption of this measure would make Florida a much less attractive place to work and live by undermining the state's ability to fulfill its current responsibilities toward its residents and make long-term investments that are fundamental to future prosperity.”

Read the CBPP report.

Amendment 8 Could Drain Billions from Public Schools

Amendment 8, the so called "Religious Freedom" constitutional amendment on the November general election ballot, could drain billions of dollars from Florida's public schools. It would rewrite the Constitution in a way that makes it easier to create a voucher program directing the use of state tax dollars to pay tuition to private schools.

Neither the ballot summary that voters will see when they go to the polls, nor the language of the amendment itself, mentions public schools. But if approved by voters, Amendment 8 would have a huge negative impact on public education, reducing funding further after years of previous education budget cuts.

K-12 budget cuts resulting from a universal voucher program pursuant to Amendment 8 could cost between $3.7 billion to $6.5 billion over five years, depending on how the voucher program is designed.

> Read the report.

Medicaid Spending Trends Do NOT Justify Opposition to Its Expansion

Although the extension of the Medicaid safety net is now the law, some governors and others opposed to the Affordable Care Act have taken to describing it as optional.  Because it has become clear that Medicaid expansion would increase the state's share of Medicaid costs by a negligible amount, opponents have been forced to try to shift the focus.

In defending his intent to reject the opportunity to extend coverage to more than a million uninsured, low-income Floridians for pennies on the dollar, Governor Rick Scott has insisted that the burden of the current Medicaid program is already too onerous.   One particular claim used by the Governor is that "Medicaid [spending] has been growing three and a half times as fast as General Revenue."

In this brief, we examine the "statistic" behind this claim and explain how it is misleading and so inapplicable to current conditions that updating the underlying data used to derive it would yield a conclusion opposite to the one advanced by the Governor and others.

The net cost to the state of extending Medicaid coverage to more than a million of the lowest-income, uninsured Floridians would be little to nothing, particularly after factoring in reductions in the cost of the delivery of "uncompensated care" in settings such as hospital emergency rooms.

> Read the report.

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The Florida Center for Fiscal and Economic Policy
579 East Call Street
Tallahassee Florida 32301
Phone: 850-325-6480
Email: info@fcfep.org

The mission of the Florida Center for Fiscal and Economic Policy is to conduct independent research, develop new ideas, and advise policymakers on state fiscal and economic policy.  The Center pays particular attention to policy impacts on low- and moderate-income individuals, families and neighborhoods, workers, and small businesses.  The Center works to heighten public awareness of the need to adequately fund programs that improve opportunities, choices, quality of life outcomes, and the economic well-being of all Floridians.