See also: Rick Scott's stranger-than-fiction smackdown of Obamacare and his defense of that decison.
In 2009, at least 2.45 million people in Florida were enrolled in Medicaid, according to data from government agencies. Another estimate pegs the number at more than 3 million. That's over a tenth of all people in the state and more than all of the people in the Tampa Bay area. All of those people are below the poverty line, and their health care is provided by a mix of federal and state funds.
But that huge population of the poor and vulnerable is now at the edge of a cliff. Republican Gov. Rick Scott is dead-set on shifting their health care to flat-rate, privatized care programs. And a portion of the Affordable Care Act that tried to build more padding into Medicaid eligibility landed with a thud in the U.S. Supreme Court chambers. Now, states are free to reject any expansion of Medicaid, as Scott did last week, when he vowed not to enforce Obamacare.
It's not too much of a stretch to imagine that the next step involves cutting Medicaid eligibility. The Affordable Care Act's proposed incentive was silly from the start: "If you don't expand Medicaid, we won't give you any money for Medicaid!"
Scott might have been OK with that. Then he'd have an excuse to
divert poor folks to a private health-care market and save some state
funds for corporate welfare or international vacations.
The part of the act that did survive the Supreme Court was the individual mandate, which (for all the Republican backlash right now) will effectively channel gazillions of dollars, under penalty of law, to large private health-insurance providers. Obamacare, as it turns out, represents a huge potential shift away from the remnants of single-payer that exist in Medicare and Medicaid and toward the "personal responsibility" of paying big corporations.
The Supreme Court decided that states can stay on the federal Medicaid dole
even if they don't expand the ranks of the insured to those just above
the poverty level. You're going to see a lot of Southern, Republican-led
states turn down the money and maintain a fragile status quo. In 2009,
Florida paid around 32 percent of an estimated $14,990,559,595 in Medicaid
health-care costs.
Sixty-four percent of Floridians on Medicaid were on managed-care plans
such as HMOs, like those favored by Scott and the Legislature, which
last year passed two bills designed to reduce expenditures and pay more flat rates to for-profit managed-care providers.
"Medicaid in its current form is an out-of-control entitlement program
which has become the single largest cost driver in our state's budget," said House Speaker Dean Cannon,
who called Medicaid a "broken program." The Obama health-care reform
assumed that states would step in line to keep their Medicaid funding.
But with it so out of favor with those in charge and so full of bloated
expenses, some might be dreaming of eliminating it.
What would a Florida with 3 million people who lost their health
coverage look like? There are already signs of how private care sets up
shop to generate healthy profits from sick, poor people.
On a PBS Frontline episode last week, reporters from the Center for
Public Integrity delved into the records of for-profit dental clinics
that serve children and adults with serious tooth decay who have slipped
through the system without proper preventive care. Doctors are expected
to meet quotas for numbers of patients served, more-expensive crowns
are pushed on customers, and dentists are sometimes awarded bonuses for
making more money. A lot of this, the report shows, channels funds from
Medicaid programs. But there's another profit channel as well: good old
American credit cards.
When a little old lady went into a dentist's office for repair work, she
said she was conned into getting a "Hollywood smile" and shuttled off
to sign up for a GM credit card that started accruing hefty interest the
moment she signed on the dotted line, before the dentist started
working on her teeth. For now, kids are protected by Medicaid and
state-run CHIP plans, even if providers try to milk the system.
It's an inefficient way to pay for services, prone to manipulation at taxpayer expense. But what are the alternatives: Charity? Church
fundraisers? Credit cards?
The U.S. government has failed to provide an enticing incentive that
governors can turn around and sell to their mad-hatter right-wing voting
blocs. Instead it was "expand the status quo or we won't give you the
status quo." Medicaid is, as Speaker Cannon said, broken. But there's a
thin layer of legislation between us and a world where there's no
incentive to care for 3 million Floridians except for the
opportunity to make a buck.
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