To extend health coverage to millions of currently uninsured Americans, the architects of Obamacare relied heavily on the idea that states would open up their already strained Medicaid programs to tens of millions of new people.
But expanding Medicaid is risky business. Not only can it lead to lower quality of care for people within the program, it can also risk busting the state budget. For almost every state in the union, Medicaid is already the single largest budget item. Florida is no exception. Expanding the program would only make it all the larger.
Obamacare envisions Florida adding one million people to its Medicaid rolls. This raises the question: Who will treat them? Medicaid pays providers notoriously low reimbursement rates. That's how the program controls costs. It is also why, according to studies such as one conducted last year by the journal Health Affairs, more and more doctors every year refuse to accept Medicaid patients. Even the most kind-hearted doctor cannot afford to treat patients at a loss.
Florida already faces a doc drain. Last fall, a Physicians Foundation survey of Sunshine State doctors found more than half the respondents plan to retire, reduce their hours or otherwise cut their workload within the next three years.
With more patients coming into the system and more doctors dropping out, something's got to give. Finding a doctor would be increasingly difficult. Wait times for appointments would increase. And odds are examinations would be more cursory, as doctors try to keep up with increasingly unmanageable caseloads. It all adds up to deterioration in the quantity and quality of individual care.
And then there's the cost issue. Obamacare promises that Washington will pick up the tab for expansion. But that promise is good only for the first three years. After that, the state has to pick up a share of the costs. And even the temporary largesse from Washington can't be guaranteed.
Washington is running annual trillion-dollar deficits with a national debt of more than $16 trillion — and the biggest drivers behind the country's fiscal crisis are health-entitlement programs. One or two years down the line, who's to say this administration won't renege on or scale back its promises to pony up extra cash to cover Florida's expansion costs?
One thing is certain: Sooner or later, Florida taxpayers would pay for Medicaid expansion. Inevitably, the bloated program would consume an ever-greater share of state revenues, squeezing other priorities such as education, emergency services and transportation.
Some supporters of expansion suggest it would save the state money — that expanding Medicaid would reduce the need to compensate hospitals for emergency-room treatments of the uninsured. But lessons from other states paint a different picture.
In recent testimony before the Florida Senate, Maine's commissioner of health and human services reported that under a similar expansion in that state, uncompensated care and state costs continued to grow, while the reduction in the uninsured for the targeted populations saw little change.
Florida is under no obligation or compulsion to expand its already stressed Medicaid program. Last year, Florida led 25 other states in challenging the administration's power to withhold Medicaid funding unless they agreed to undertake the Obamacare expansion. The Supreme Court ruled in Florida's favor, saying Washington had no right to coerce states that way.
Now is the time for Florida to separate itself further from the flawed law and pursue more-affordable, more-effective health reforms. The state can do much better than Obamacare to help those in need.
-Nina Owcharenko is director of the Center for Health Policy Studies at the Heritage Foundation, a conservative Washington think tank.
First appeared in Orlando Sentinel.