The Affordable Care Act (ACA), enacted on March 23, 2010, expanded the Medicaid program significantly as part of a broader plan to cover millions of uninsured Americans. Specifically, the ACA expanded Medicaid eligibility to reach nearly all non-elderly adults with incomes at or below 138% of the federal poverty level (FPL) – about $16,105 for an individual in 2014 – establishing a new coverage pathway for millions of uninsured adults who were previously excluded from the program, effective January 1, 2014.
The law also provided for 100% federal funding of the expansion through 2016, declining gradually to 90% in 2020 and future years. However, the Supreme Court ruling on the ACA in June 2012 effectively made the Medicaid expansion optional for states, and many states including Florida have elected to forgo the expansion. (Kaiser Foundation)
Now, with President Trump in office, there is great uncertaintly. Republicans in control of Congress have vowed to repeal the ACA, and now they have the votes to do it. They could replace the entire Medicaid program with a "block grant" to Florida and it would be up to the Legislature to handle it from there. We are not confident they will do so. We'll continue to work for available, affordable healthcare for everyone.
If the state is not willing to pass a program to fund minimum health care for Florida's most needy patients, then it will be up to local governments to do so according to their own standards. We now have a mish-mash of plans that cover nothing up to fairly decent coverage. Funding comes from sales taxes or property taxes, which would go up to replace Federal and State funds. Most Floridians are not willing to turn the sick out into the street. In some places, that means low income residents will return to going to the emergency room for care, the most expensive option.
Across the state, people are waiting to see what happens in Washington so we know what we have to do here at home. FCAN encourages members and supporters write to their member of Congress and ask them to preserve the parts of the Affordable Care Act that you like, or all of it. Popular provisions include kids on parents plans until 26, no pre-existing condition, no-lifetime limits, and requiring everyone to have insurance.
Medicaid eligibility today varies greatly from state to state. In many states, parents cannot get
coverage unless their incomes are very low and many adults without dependent children cannot
get coverage at all. This holds true inn Florida, where the income threshhold for childless adults is 19% of the Federal Poverty line if unemployed, and 56% for the employed.
The poverty line in 2014 was $19,790 for a family of three.
In Florida, there are currently 1,552,000 uninsured adults who would be eligible for Medicaid if the state expanded its Medicaid program. Of these, 1,295,000 would be newly eligible for Medicaid if the state expanded, while 257,000 are eligible for the program under current rules but are not enrolled.
If Florida expands Medicaid, an additional 1,276,000 adults who will be newly eligible for the program will enroll. These comprise mostly uninsured adults, but also include some adults who currently have other health care coverage.
Even if Florida does not expand, enrollment is expected to increase by 357,000 as parents and children who are already eligible for Medicaid enroll in health coverage because other aspects of the Affordable Care Act (ACA) including the requirement for people to have coverage or pay a penalty, outreach to enroll people into exchange subsidies, and improved coordination and simplified eligibility procedures.
Florida will spend $3.5 billion more on Medicaid to cover additional enrollment of currently eligible children and parents through 2022 with or without the expansion. The expansion would increase state spending by $5.4 billion. Altogether, this additional spending is just 7.9 percent more than what Florida would have spent on Medicaid in the absence of the ACA.