Expansion would push tens of thousands who weren’t eligible for Medicaid before expansion to be kicked off the health plans they currently have and like, and force them to use the broken Medicaid system.
If some well-intentioned but misguided activists are successful, many lower-income Floridians are going to end up a lot worse off. A group called Florida Decides Healthcare is attempting to put a proposal on the ballot to expand Medicaid coverage to able-bodied, single adults with no children.
That might sound like a good thing. Who could be against “more coverage”? But as we’ve seen in state after state that has tried it, the reality is quite different.
Expansion would push tens of thousands who weren’t eligible for Medicaid before expansion to be kicked off the health plans they currently have and like, and force them to use the broken Medicaid system. It would also devastate our state budget. Medicaid already accounts for one-third of state spending. Expansion would cost Florida taxpayers at least an additional $1 billion a year, leading to huge tax increases while restricting funding for other services. And the proposal itself violates the state constitution.
The state receives $1.60 from the federal government for every dollar it spends to cover the most vulnerable on traditional Medicaid. Under expanded Medicaid, the feds would provide $9 for every dollar Florida spends on able-bodied adults. That would incentivize Tallahassee to spend more on able-bodied adults than sick individuals, leaving vulnerable patients with longer wait times and fewer choices.
Proponents of Medicaid expansion are barking up the wrong tree. That’s why, for years, our elected representatives have rejected their efforts.
So now, they want to put it on the ballot for Floridians to vote on directly. But the proposal and its language don’t jibe with the Sunshine State’s constitution.
Under Article XI, Section 3 of our constitution, the people may propose an amendment to the constitution, provided that it involves only one subject. As currently written, the proposal violates this single-subject rule.
The amendment would force the executive branch to implement the program and mandate that the legislature find the money to pay for it. This substantially performs or alters the operations of two branches of government by expanding Medicaid and permanently opting-in to the federal Medicaid program. Most critically, it eliminates the legislature’s discretion in appropriating funds.
In 1997, the state Supreme Court struck down a similarly structured proposal that would have required the legislature to appropriate 40 percent of the budget for public education funding. The court concluded that, in addition to performing executive branch and local government functions, the proposed amendment “would substantially alter the legislature’s legislature’s present discretion in making value choices as to appropriations among the various vital functions of State government.”
The same is true in the case of the Medicaid proposal.
Aside from the obvious constitutional issue, the wording of the amendment’s title and summary is misleading. “Provide Coverage to Eligible Low Income Adults” sounds awfully sunny, but it obscures the huge scope and cost of the proposed change.
The summary is similarly positive and vague. “Implement the initiative by maximizing federal financial participation” doesn’t make it clear that Florida taxpayers will have to foot at least 10 percent of the bill for the expanded population — a sum that could easily be in the billions.
Florida voters should not be hoodwinked into voting for an amendment that would expand a broken system and lock our legislature into a constitutional mandate that permanently diverts limited resources away from education, roads and other government responsibilities.
Every Floridian deserves access to high quality, affordable health care. But Medicaid expansion isn’t the way to get there.
Earlier this year, Florida partially repealed its certificate-of-need law that required health care providers to get permission from the state to expand services. It’s already having an effect, with providers planning new locations and services.
Other patient-centered reforms such as expansion of telemedicine and removing restrictions that prevent nurse practitioners from making full use of their professional training would expand access, drive down costs and boost the quality of care. Those should be the goals of health care reform.
The state Supreme Court should not let this unconstitutional proposal move forward.
SKYLAR ZANDER, TALLAHASSEE
Editor’s note: Zander is the Florida state director of Americans for Prosperity.