After meeting privately with HHS Secretary Sylvia Mathews Burwell on Wednesday, Florida Republican Gov. Rick Scott emerged defiant, declaring his absolute opposition to expanding Medicaid under the Affordable Care Act.
In a news conference in front of HHS' Washington offices, Scott said that the only reason he met with Burwell was to push for an answer to his administration's April 20 application to renew a waiver that has given Florida between $1 billion and $2 billion annually in supplemental Medicaid waiver funding to help hospitals with uncompensated-care costs. That low-income pool waiver originally was privately negotiated in 2005 between the administration of President George W. Bush and then-Florida Gov. Jeb Bush.
The Obama administration has tied renewal of the waiver—which it warned a year ago was ending—to Florida's expansion of Medicaid to adults with incomes up to 138% of the federal poverty level. HHS and CMS officials have said the administration does not want to provide supplemental hospital-care funding for people whom Florida could cover through a Medicaid expansion. Florida's GOP-led Senate agrees with the Obama administration's position and passed a Medicaid expansion bill. Florida hospitals and many business groups also are pushing hard for the Senate's Medicaid expansion plan. But Scott and the GOP-led state House oppose any expansion and simply want the low-income pool extended.
“We need that (low-income pool) approval immediately so we can start a special session and pass a budget,” said Scott, the former CEO of Columbia/HCA who, as governor, originally opposed Medicaid expansion, then supported it, then recently came out against it once again. “If we do not get any answer from CMS in the next few weeks, their inaction is the same as a no,” he said.
Scott said Burwell did not provide a timeline for when HHS would make a decision about the supplemental waiver funding. He declined to say if she reiterated the need for the state to expand Medicaid for that funding to continue.
In April, the CMS informed the state of Florida that: “The future of the (low-income pool), sufficient provider rates and Medicaid expansion are linked.” Last week, Scott filed a lawsuit against HHS, claiming that it's unconstitutional coercion for the federal government to tie Medicaid expansion to the waiver funding. Days later, Republican governors in Kansas and Texas, whose states also are at risk of losing their Medicaid supplemental funding if they don't expand Medicaid, said they'll join Scott's lawsuit.
Scott is now drafting a basic budget that would fund critical services in the state, assuming the state's House and Senate can't come to an agreement over the budget before the next fiscal year that begins July 1. The two chambers have been at an impasse. The Senate's budget includes $4 billion in federal funding from Medicaid expansion and renewal of the waiver, while the House budget does not include those federal dollars.
Scott said Wednesday that a major reason he opposes Medicaid expansion is his concern that the federal government can't be relied on to continue funding the Florida Medicaid expansion population, which is estimated to total more than 800,000 people. He argued that those who receive care through the state's low-income pool funding are a different population than those who would gain coverage under Medicaid expansion, though he offered no evidence for that claim. Many experts say it's largely the same population.
“How can they walk away from this group of low-income families, to say we're going to take care of this (other) group of low-income families, but trust us, we'll never change our minds,” Scott said. “You would never do business with someone like that.”
Hospital leaders and other supporters of Medicaid expansion argue that Medicaid expansion is a good deal for Florida because under the Affordable Care Act, the federal government pays 100% of the cost for covering newly eligible beneficiaries through 2016, with that contribution phasing down to 90% by 2020. It's projected that would bring $50 billion in additional federal Medicaid funding to the state over 10 years. And it would take an act of Congress to change that mandatory federal contribution level, noted Deborah Bachrach, a partner in the law firm of Manatt, Phelps & Phillips and former Medicaid director of New York state.
There is no precedent for Congress to withdraw basic Medicaid funding from any state. Experts point out that the low-income pool funding is part of a discretionary waiver program, while the Medicaid expansion funding is a statutory entitlement.
On the other hand, Republican leaders in Congress have proposed to repeal the ACA and its Medicaid expansion, turn Medicaid into a capped state-block grant program and slash funding by nearly $1 trillion over 10 years. So Scott's concerns could become a reality if Republicans take the White House and keep control of Congress in next year's elections.