With its selection of a brand new chief, the Florida Hospital Affiliation has signaled that looking for legislative approval to develop Medicaid to almost 850,000 uninsured adults will not be amongst its high priorities.
In October, Mary Mayhew grew to become the affiliation’s CEO. Mayhew, who led the state’s Medicaid company since 2019, has been a vocal critic of the Reasonably priced Care Act’s Medicaid growth adopted by 38 different states. She has argued that growth places states in a tough place as a result of the federal authorities is unlikely to maintain its monetary dedication to pay its share of the prices.
Had Medicaid been expanded in Florida, hospitals there would have gained 1000’s of paying sufferers. However the establishments have completed little in recent times to steer the Republican-led legislature and Gov. Ron DeSantis, additionally Republican, who oppose such a transfer.
Mayhew acknowledged in an interview with KHN that increasing Medicaid to cowl extra uninsured sufferers may assist hospitals financially, particularly at a time when amenities have seen demand for providers decline as folks keep away from take care of concern of contracting COVID-19.
With that in thoughts, she mentioned, she is now open to the concept of increasing Medicaid. “We have to take a look at all choices on the desk,” she mentioned. “Is it doable? Sure.”
Nonetheless, she was fast to level out considerations about whether or not Florida can afford to develop.
Below the ACA, the federal authorities pays 90% of the prices for newly enrolled Medicaid recipients. Within the conventional Medicaid program — which covers kids, people who find themselves disabled and pregnant ladies — the federal authorities pays almost two-thirds of Florida’s Medicaid prices.
“Will probably be financially difficult in our state price range as revenues have dropped,” Mayhew mentioned, echoing feedback of state officers. “That 10% value has to come back from someplace.”
Mayhew’s rent worries advocates who’ve spent greater than seven years lobbying lawmakers to develop Medicaid. With out robust help from the hospital business, they concern they’re unlikely to vary many votes.
“It could make it more durable,” mentioned Karen Woodall, govt director of Florida Individuals’s Advocacy Middle, a gaggle that lobbies for insurance policies to assist low-income residents. Marshaling hospital help is essential, she mentioned, due to the business’s cash and political clout.
In lots of state capitals, hospitals have led the struggle for Medicaid growth both by lobbying lawmakers or bankrolling poll initiatives. The most recent instance was in Missouri, which this summer season expanded Medicaid by way of a voter initiative. The marketing campaign for the measure was partly funded by hospitals.
However in Florida, hospitals seem to have made a calculated choice to keep away from pushing an initiative that Republican leaders have mentioned they do not need. Among the many dozen states that haven’t expanded Medicaid, Florida is second solely to Texas within the variety of residents who may acquire protection.
Aurelio Fernandez, CEO of Memorial Healthcare System in Hollywood, Florida, who was chair of the hospital affiliation board when it employed Mayhew, mentioned her opposition to Medicaid growth by no means got here up within the course of. The affiliation employed Mayhew due to the “phenomenal job” she did guiding hospitals amid the COVID pandemic, he mentioned.
“There is no such thing as a urge for food at this juncture [for the legislature] to develop the Medicaid program with Obamacare,” mentioned Fernandez, regardless of his perception that growth would assist hospitals and sufferers.
Mayhew, sounding extra like a state official than a hospital business spokesperson, mentioned the last word choice on growth might be as much as lawmakers, who should evaluate spending priorities. When states face a monetary crunch, lawmakers look to scale back spending in schooling and Medicaid, that are the largest components of the price range, she mentioned.
“The very last thing we need to see is the state price range balanced on the backs of hospitals with deep Medicaid reimbursement cuts,” Mayhew mentioned.
Mayhew mentioned her earlier opposition to increasing Medicaid occurred when she was answerable for balancing the state price range and managing the packages in Florida and, earlier than that, in Maine. When she ran Maine’s program, she mentioned she opposed increasing Medicaid to permit nondisabled adults into this system whereas there have been disabled enrollees already on ready lists to get care.
The Florida Hospital Affiliation, which represents greater than 200 hospitals, spent years lobbying state lawmakers to develop Medicaid. However since DeSantis was elected in 2018, the group has centered on different points as a result of the governor and Republican lawmakers made clear they might not develop this system.
Requested what the affiliation’s present place is on Medicaid growth, Mayhew famous she has been in her job lower than a month and “we’ve got not had that coverage choice by the board for me to reply that.”
Miriam Harmatz, govt director of the Florida Well being Justice Venture, an advocacy group, mentioned Mayhew’s rent means that hospitals are unlikely to get behind a fledgling effort to place the growth query to voters in 2022.
Others advocating for Medicaid growth agree.
“It doesn’t seem like they [Florida’s hospitals] are on board with serving to us develop Medicaid in the meanwhile,” mentioned Louisa McQueeney, program director of Florida Voices for Well being, a client group serving to with the poll initiative.
This text was reprinted from khn.org with permission from the Henry J. Kaiser Household Basis. Kaiser Well being Information, an editorially unbiased information service, is a program of the Kaiser Household Basis, a nonpartisan well being care coverage analysis group unaffiliated with Kaiser Permanente.