Florida Senate files bill to expand Medicaid, create state-run health insurance exchange

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MIAMI — An alternative to Medicaid expansion is being proposed in the Senate in a bill that would use federal funds to offer health insurance to nearly 1 million low-income Floridians.

Thursday's proposal from Sen. Aaron Bean's Health Policy Committee will still allow the state to take billions of federal dollars, but would give consumers vouchers to purchase private insurance. The Republican-led Legislature has been opposed to Medicaid expansion but has been more open to this option.

The bill would require the expanded Medicaid population to pay monthly premiums of no more than $25 and modest fees for emergency room visits to encourage accountability. There's a 30-day grace period for missed payments, but health advocates are concerned because consumers would be suspended from the program after that and wouldn't be allowed to get insurance for six months.

Recipients would also have to be employed or in school. Adults without children would not receive coverage. Under the proposal, the Florida Health Insurance Affordability Exchange would also include the state children's insurance program and the current Medicaid managed care population.

A similar bill was proposed two years ago as a compromise, but it died in the House and new Republican House Speaker Steve Crisafulli has all but shut the door on the issue. Republicans say they don't want to expand an already broken system and also worry the federal government won't follow through on its payment promise, leaving the state to foot the bill. The federal government would fully fund Medicaid expansion through 2016 and pay roughly 90 percent after that.

Medicaid expansion supporters thought the potential loss of the federal funds to hospitals that care for a large number of low-income patients could provide the catalyst needed to convince Republican lawmakers to expand Medicaid rather than dipping into the stage budget. Federal funding for that program is slated to end in June, but Gov. Rick Scott and state health officials are negotiating with federal officials to continue the funding.

The Senate bill could also provide a potential solution if the Supreme Court rules against the subsidies given under so-called Obamacare because the exchange could be expanded to eventually include the 1.6 million Floridians who are currently insured through healthcare.gov.

A Supreme Court ruling this summer could strike down subsidies for millions of consumers who bought insurance through the federal marketplace. Florida has the most to lose with 93 percent of its 1.6 million enrollees receiving subsidies.

Senate President Andy Gardiner is opposed to a straight Medicaid expansion, but he says the potential loss of the hospital funds and the option to expand has the state "at an important crossroads in the Medicaid program."

"We have the obligation to make coverage affordable and the opportunity to develop a consumer-driven approach — one that provides access to high-quality, affordable health care coverage while promoting personal responsibility," he said in a statement.

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