September 19, 2011

While newly released Census estimates painted a bleak picture for Floridians with respect to income levels and poverty rates in 2010, health insurance coverage rates, though still unacceptably low, actually improved slightly.  The difference-maker?  None other than public enemy No. 1 of the Florida Legislature: the Medicaid program.

Focusing on a few of the numbers:

·        The estimated percentage of Florida children who were uninsured in 2010 – 14.2 percent – was (statistically significantly) lower than in any other year since 2004.  In terms of raw numbers, the 2010 estimate of 576,000 uninsured kids came in 135,000 below 2009 levels, although Census  Bureau officials advise us not to make too much of single year comparisons. 

·        The estimated total number of uninsured Floridians decreased by a similar amount (142,000), from 4 million to 3.85 million. (As widely reported, that still left more than one in five - 20.7 percent – Floridians without coverage, the third highest rate of any state in the U.S.) 

Then, examining these numbers more closely:

·        Among children, the number covered by private health insurance coverage remained steady from 2009 to 2010, but nevertheless remained far below pre-recession levels. By contrast, the estimated number covered through Medicaid in 2010 jumped by 223,000.  This more than accounts for the decrease in the estimated number of uninsured kids.

·        Among all Floridians, the overall level of private health insurance coverage was statistically unchanged from the previous year.  At the same time, Census estimates show 330,000 more Floridians had to rely on (and be poor enough to qualify for) Medicaid coverage in 2010 than in 2009. Actual Medicaid enrollment figures are not inconsistent with these estimates.

The Census estimates therefore bring several important issues to light:

·        The resource that almost single-handedly prevented the “un-insurance” crisis to which we are “accustomed” from exploding into an even more dire threat to Florida and Floridians is Medicaid.  As families continued to lose income and coverage options, the Medicaid safety net caught them.

·        When legislative leaders lamented (incorrectly) that Medicaid is spiraling out of control, it is the fact that Medicaid has served as a safety net that they lamented.  And when they demanded flexibility from “oppressive” federal Medicaid requirements, it is the flexibility to cut Medicaid eligibility they sought.  For instance, the Senate’s version of last year’s Medicaid bill called for automatic eligibility cuts.

·        The Affordable Care Act (ACA) is key to Medicaid’s ability to prevent growth in the ranks of uninsured Floridians in the shorter term as well as to its ability to make a significant dent in un-insurance in Florida in the longer term. Specifically, it is the ACA’s “Maintenance of Effort” requirement that prevents Medicaid eligibility cuts, and it is the ACA’s Medicaid coverage expansion that will significantly reduce un-insurance among the lowest-income Floridians starting in 2014.


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