With its alternative of a brand new chief, the Florida Hospital Affiliation has signaled that searching for legislative approval to broaden Medicaid to almost 850,000 uninsured adults will not be amongst its prime priorities.
In October, Mary Mayhew turned the affiliation’s CEO. Mayhew, who led the state’s Medicaid company since 2019, has been a vocal critic of the Inexpensive Care Act’s Medicaid enlargement adopted by 38 different states. She has argued that enlargement 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 hundreds of paying sufferers. However the establishments have executed little lately 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 might assist hospitals financially, particularly at a time when services 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 thought 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 issues about whether or not Florida can afford to broaden.
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 girls — the federal authorities pays practically two-thirds of Florida’s Medicaid prices.
“Will probably be financially difficult in our state finances 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 broaden Medicaid. With out robust assist 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 Folks’s Advocacy Heart, a bunch that lobbies for insurance policies to assist low-income residents. Marshaling hospital assist is vital, she mentioned, due to the business’s cash and political clout.
In lots of state capitals, hospitals have led the combat for Medicaid enlargement both by lobbying lawmakers or bankrolling poll initiatives. The most recent instance was in Missouri, which this summer time expanded Medicaid through 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 might 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 enlargement by no means got here up within the course of. The affiliation employed Mayhew because of the “phenomenal job” she did guiding hospitals amid the COVID pandemic, he mentioned.
“There isn’t any urge for food at this juncture [for the legislature] to broaden the Medicaid program with Obamacare,” mentioned Fernandez, regardless of his perception that enlargement would assist hospitals and sufferers.
Mayhew, sounding extra like a state official than a hospital business spokesperson, mentioned the last word choice on enlargement will likely be as much as lawmakers, who should evaluate spending priorities. When states face a monetary crunch, lawmakers look to scale back spending in training and Medicaid, that are the largest components of the finances, she mentioned.
“The very last thing we wish to see is the state finances 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 liable for balancing the state finances and managing the applications 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 broaden Medicaid. However since DeSantis was elected in 2018, the group has targeted on different points as a result of the governor and Republican lawmakers made clear they’d not broaden this system.
Requested what the affiliation’s present place is on Medicaid enlargement, Mayhew famous she has been in her job lower than a month and “now we have not had that coverage choice by the board for me to reply that.”
Miriam Harmatz, govt director of the Florida Well being Justice Mission, an advocacy group, mentioned Mayhew’s rent means that hospitals are unlikely to get behind a fledgling effort to place the enlargement query to voters in 2022.
Others advocating for Medicaid enlargement agree.
“It doesn’t appear like they [Florida’s hospitals] are on board with serving to us broaden Medicaid in the meanwhile,” mentioned Louisa McQueeney, program director of Florida Voices for Well being, a client group serving to with the poll initiative.
KHN (Kaiser Well being Information) is a nonprofit information service protecting well being points. It is an editorially impartial program of KFF (Kaiser Household Basis) that is not affiliated with Kaiser Permanente.