Florida lawmakers considering how to implement the federal health care overhaul sought information this week from two economists on the Massachusetts initiative that served as the blueprint for the national plan.
Massachusetts pioneered an approach emulated in the federal Affordable Care Act with its 2006 health care initiative and is currently the only state that requires individuals to have health insurance.
“I thought it would be helpful to examine the results so far in Massachusetts and consider implications of that experience for Florida. Not everyone agrees with the Massachusetts experiment and how it’s turned out,” said Republican Sen. Joe Negron, the chairman of a Senate committee studying the health overhaul.
Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who helped craft the state’s law, hailed it as “a great success” that dropped the number of uninsured residents by two-thirds and lowered premiums by about 50 percent. He said the initiative did so without crowding out private insurers.
But Michael Cannon, director of Health Policy Studies for the Cato Institute, argued that the law depresses economic activity, eliminates jobs and increases health care costs along with burdening the federal government.
He reminded lawmakers that Florida led the country in challenging the constitutionality of the ACA and said that it shouldn’t respond to Supreme Court decisions that have given states leeway on whether to expand Medicaid “by shrugging and implementing that costly Medicaid expansion anyway.”
Florida lawmakers are facing two major decisions regarding the federal health overhaul. They must choose whether to expand Medicaid coverage to roughly 900,000 more low-income families and whether to have the state run its health exchange on its own or partner with the federal government. The federal government is offering to pick up the entire tab of the Medicaid expansion for the first three years and about 90 percent after that.
Florida spends about $21 billion a year to cover nearly 3 million of the state’s poorest residents, about half of whom are children.
Gruber said that if Florida does not expand Medicaid it will lead to higher premiums for those shopping for coverage in the state health exchange because hospitals will still have to cover uninsured patients in crisis.
Cannon, however, urged state senators to reject an expansion, saying there’s little reliable evidence the taxpayer-funded program improves health outcomes and no evidence of cost savings. He said states can’t afford it.
Republican Gov. Rick Scott has echoed similar concerns about the cost of Medicaid expansion. Earlier this month, Scott estimated it would cost $26 billion over a decade, but the state health agency later revised that figure to $3 billion after pressure from lawmakers who accused Scott of trying to play politics with the numbers.
Cannon urged lawmakers not to create a state health exchange and instead file a “lawsuit to block the IRS illegal taxes and even prevent the federal government from operating an exchange here in Florida.”
The new marketplaces are intended to take the confusion and anxiety out of buying private health insurance for individuals and families. Exchanges are meant to have the feel of an online travel site, such as Expedia or Orbitz.
Cannon estimates that refusing a health exchange would exempt 1.1 million Floridians from having to pay penalties for not purchasing insurance.
Gruber encouraged lawmakers to consider small practical steps, such as setting up an evaluation process so the state can see what choices residents are making in the exchange, how they’re arriving at those decisions and whether it’s the most beneficial choice for them.
Negron asked Cannon to explain why conservatives, who typically bristle at federal government intervention, are urging states to allow the feds to run their exchanges.
“How did it turn out those arguments seem to have been flipped?” he asked.
Cannon said the states that choose to run a health exchange are doing so in name only because the federal government is still calling the shots.
Later, he struggled to find an answer when Negron repeatedly pressed how a family of four making $25,000 a year should pay for health care if the state didn’t offer Medicaid.