Virginia's lessons for Florida on Medicaid expansion

A Tampa Bay Times Editorial

A Democratic governor open to compromise. A more evenly divided legislature, with some conservative Republicans finally ready to provide more low-income constituents with access to health care. Another state that wisely accepts Medicaid expansion money to cover hundreds of thousands of residents.

That describes Virginia, where last week the legislature voted to join 32 other states in accepting Medicaid expansion money. It could describe Florida next year. All voters have to do is declare health care a top priority this fall and elect a new governor and more legislators who would work together to agree on a plan to accept billions from the federal government and expand access to health care. Elections have consequences, and health care will be one.

There are lessons for Florida in the victory for health care access in Virginia. The battle to accept Medicaid expansion money had been unsuccessful for years, but voters elected Democratic Gov. Ralph Northam, who developed relationships within the Republican-led legislature. They also elected more Democrats to the legislature, narrowing the Republicans' advantage and requiring fewer Republican votes needed to approve the Medicaid expansion plan.

Second, the Trump administration and Congress inadvertently made it easier for Virginia to accept the money. They fortunately failed to repeal the Affordable Care Act, finally convincing some Republican state lawmakers that the federal law that provides for Medicaid expansion is not going away. Second, the administration began approving work requirements for able-bodied adults on Medicaid, satisfying concerns of some conservatives in Virginia and elsewhere. The Virginia plan also includes another conservative provision first adopted in Indiana that requires Medicaid recipients to pay at least a small monthly premium.

Work requirements and small monthly premiums for families so poor they qualify for Medicaid seem punitive. Florida legislators did not consider work requirements for the state's existing Medicaid plan this spring because the plan already is so skimpy it excludes able-bodied childless adults. But the trade-off of those requirements for extending health coverage to 400,000 low-income Virginians is a reasonable one, and that could be what it takes to bring Medicaid expansion to Florida.

Finally, four conservative Republican senators in the Virginia Senate, including some in strong pro-Trump districts, summoned the courage to vote for Medicaid expansion and it passed that chamber by 23-17 in a special session. The governor is expected to sign it into law this week. Meanwhile, Utah and Idaho are expected to have Medicaid expansion initiatives on the ballot this fall. Just as the original Medicaid program took a few years to expand nationwide in the 1960s, the expansion is slowly continuing to take hold.

Floridians should not be left behind. A new report from the Centers for Disease Control and Prevention shows Florida has the third-highest portion of uninsured adults in the nation, at 20.1 percent in 2017. That's up from 19.8 percent the year before. The average percentage of uninsured adults is more than double in states that have not accepted Medicaid expansion money than in states that have accepted the money. Remember that the federal government will pay 90 percent of the cost of expansion, which could mean roughly $5 billion a year for Florida. And remember that nearly 1 million additional low-income Floridians could receive access to health care.

Five years ago, the Florida Senate voted 38-1 for a plan to accept Medicaid expansion money that would have saved the state millions. The Florida Chamber of Commerce, Associated Industries, the health care industry and most voters supported taking the federal money. Yet the Republican-controlled House led by two Pasco County lawmakers, then-Speaker Will Weatherford and current Speaker Richard Corcoran, refused to budge and denied access to health care for hundreds of thousands of Floridians.

It took Virginia five years to see the light. Why can't Florida be next?