The effort to bring Medicaid expansion to Florida will have to wait at least another year — even though many other southern states that resisted the expansion offered under Obamacare have had second thoughts and changed direction.
The question is whether Florida will be one of the last states in the nation to enact expansion — similar to how it was among the last states to enact the initial Medicaid program that was first authorized in 1965. Florida did not come on board until five years later.
"If Congress were to ever repeal Medicaid expansion and Obamacare, I'd be the first in line in support of that," said state Rep. Joel Rudman, a conservative Republican and doctor who now says Florida should support expansion. "But the fact of the matter is, they are never going to. And when you escape that reality, to simply refuse federal dollars for a program that's never going away is just absurd."
After North Carolina voted to expand Medicaid, other southern states, including Mississippi and Georgia, have been considering doing the same.
Republican lawmakers in Mississippi, the poorest state in the nation, are debating the issue now, with the House approving legislation earlier this month. Republican Gov. Tate Reeves, though, posted his opposition to the proposal on X, formerly Twitter.
Georgia House Speaker Jon Burns, a Republican, told the state chamber of commerce in January that "expanding access to care for lower-income working families through a private option — in a fiscally responsible way that lowers premiums — is something we will continue to gather facts on in the House."
Medicaid expansion, as it has been in the past, was a no-go in Florida this year. Senate President Kathleen Passidomo, who led the charge to push through a health care workforce overhaul this year, remained adamantly opposed to expansion, as did other legislative leaders and Gov. Ron DeSantis.
That didn't stop Rudman, however, from trying to build groundwork for another try.
Rudman met with North Carolina state Sen. Kevin Corbin in Tallahassee this Session to discuss the steps that Florida could take toward expanding Medicaid, as well as North Carolina's experience since passing and implementing a Medicaid expansion effective Dec. 1, 2023. Rudman also arranged to have Corbin meet about a dozen Republicans to talk about the issue.
"North Carolina was very hesitant to take Medicaid expansion. You know, three, four or five years ago, there was a lot of hesitation among Republicans who felt like it was a buy-in to a continuation of Obamacare, and that we would be spending money loosely," Corbin told Florida Politics in February at a meeting in Rudman's Capitol office.
"So over a period of four or five years, I think we've come to understand — and folks like myself have been the ones to promote it — that it was going to be good for our citizens."
Corbin said the North Carolina expansion — the state portion of which is funded by revenues from hospitals — is expected to cover 600,000 new people.
"As a Republican and as a conservative, I would agree with a lot of my colleagues that if there was, if there was a private industry solution to this, we should take it," Corbin said. "It's been 14 years. There hasn't been a private industry solution or a private solution. This worked. So it's a matter of: Are we going to address this coverage gap? And in North Carolina, have we come to a decision? Yes, yes, we are."
Under the Affordable Care Act, the federal government pays 90% of the costs of expanding Medicaid to childless low-income adults; the states are responsible for the remaining 10%. The American Rescue Plan Act passed in 2021 includes an additional 5% bump for Obamacare expansion for the first two years following a Medicaid expansion.
Corbin was invited to Tallahassee by an umbrella organization promoting better health care access called For Florida's Health, of which The American Cancer Society Cancer Action Network (ACS CAN) is a member.
ACS CAN Florida Government Relations Director Susan Harbin said her organization is excited about the bipartisan conversations that she said are occurring in Florida, a state where less than 40% of the employers offer health insurance to employees. Plans that are offered can be costly and out of reach for many of the workers.
"More than 160,000 people will be diagnosed with cancer in the Sunshine State this year. We know having health insurance is the main determinant of whether people survive the disease. In addition, states that have closed the coverage gap give patients a significantly better chance of cancer survival," she said.
Corbin acknowledged that in North Carolina, politics was the driving reason initially behind the state's decision to not expand Medicaid to lower-income uninsured adults.
"Early on, I think a lot of folks were afraid that if we voted for Medicaid expansion, if we supported that, we would be criticized by our party, and a lot of us would be subjected to Primary Elections that folks run against us for that reason. And they would come at us with, 'Hey, you're, you're supporting a Democrat initiative,' and those kinds of things," he said.
But none of the Republicans in that state's Senate were facing a Primary challenge as of mid-February. "People can have a Primary for any reason, including (Medicaid expansion). So it just has not been a political issue in North Carolina," he said.
A March survey of 800 likely General Election Florida voters shows that 60% of them are more likely to vote for an elected official who supports a Medicaid expansion, whereas 13.4% would be less likely to vote for an elected official who supports an expansion.
A majority of non-college-educated voters, a key bloc in Florida elections, are more likely to vote for elected officials who support a Medicaid expansion. Another 11.5% said the support of a Medicaid expansion wouldn't impact how they voted, and the remaining 13.6% said they were unsure.
The survey results were posted shortly after organizers began a campaign to put Medicaid expansion on the 2026 ballot, when there will be a wide-open race for Governor.
In a sign that Medicaid expansion still remains a touchy issue with some Florida Republicans, though, Rudman declined to name the legislators who met with Corbin out of fear of retribution.
"After having five of my last seven bills killed after coming out in favor of Medicaid expansion, I have no desire to return the favor on those who are willing to listen to reason. They can make themselves and their own feelings known, but I will not out them publicly," he said. "It was common knowledge around Tallahassee. Lobbyists I never met were stopping me in the street saying that's what happened to my bills."
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