The Health Care Gap in the Sunshine Economy

Apr 20, 2015

Credit Miami Herald

More than three-quarters of a million Floridians live in a health care gap. The gap was created by the national Affordable Care Act and Florida's rejection of an expanded Medicaid program. In between the two policies is a gap in medical insurance coverage where 850,000 Floridians find themselves.

For two years Florida lawmakers have decided not to accept the federal government's offer to shoulder mosts of the cost of an expanded Medicaid program. Once again, the debate over expansion is raging in the Florida Legislature. It has divided Republicans, who hold a majority in the Florida House and Senate, and it is holding up the state budget.

Florida isn't alone in not expanding Medicaid, the health insurance plan aimed at low income parents and children and disabled adults. It is one of 22 states that have not expanded the program. 

By not expanding Medicaid, thousands of Floridians are not eligible for the program, but they don't make enough money to qualify for tax credits through the Affordable Care Act to help buy health insurance on the federal exchange. They have fallen into the health care gap. 

How Much You Make Matters

Health care insurance help depends on income. The tax credit for a subsidy to buy health insurance is based on household income and the federal poverty level. Depending upon the number of people in your household, a household has to earn at least the federal poverty level (represented in blue below). In Florida, in order to qualify for Medicaid, adults who are not disabled or pregnant must have dependent kids and earn an income below 35 percent of the federal poverty level (in red below). 

For Floridians without dependent children and who are not disabled or pregnant, if they don't make at least the federal poverty level, they are at risk of falling into the health care coverage gap. If they made more money, they could be eligible for tax credits to buy health insurance.

Opponents of Medicaid expansion express worries over the federal government's willingness to keep its pledge to fund 90 percent of the cost of an expanded program in future years. (The federal funding is 100 percent initially.) The political action committee Americans for Prosperity is opposed to expansion, arguing the current system is inefficient, in part by its fee-for-service strategy. The group argues that the pay structure rewards health care providers for doing tests and other services that may not improve the health of patients.

Supporters counter that the health care for those people in the coverage gap is delivered through charity care, pushing the costs onto insured patients. The Robert Wood Foundation, an expansion supporter, looked at eight states that expanded Medicaid. It figures together they have experienced a positive $1.8 billion impact on their budgets.

There is no deadline to expand Medicaid or not. Florida's next fiscal year budget has to be in place by July 1, 2015.