Supreme Court ruling on health care sets stage for policy, funding decisions

The U.S. Supreme Court on Thursday upheld the 2010 federal health care law, but also held states like Florida should have flexibility in deciding whether to expand Medicaid.

Attorney General Pam Bondi, who represented Florida in its lawsuit against the Affordable Care Act, said she was disappointed in the outcome, but welcomed the Medicaid decision and the limits the court recognized on the federal government's power. Gov. Rick Scott, a former hospital executive who launched his career in politics by forming a group to oppose the law, called on Congress to change it.

"Everybody that said it wasn't a tax, they need to repeal it," Scott said, referring to the court's conclusion that Congress could use its taxing authority to penalize people who did not buy health insurance. "We just keep raising the cost of living in our state, and we can't do it."

If the law remains in place, Florida will face a series of choices in the upcoming year about how to implement the law its elected leaders opposed, and whether it wants to extend Medicaid coverage to hundreds of thousands of new patients.

The law would have extended Medicaid coverage to everyone earning below 133 percent of the federal poverty level and increased federal support for the program by funding the Medicaid expansion in its entirety through 2016, with the federal share falling to 90 percent in later years. That could fuel a 35 percent expansion of Florida's program by 2019.

The federal government currently funds about 55 percent of Florida's $21.2 billion Medicaid program.

Senate Health Appropriations Chairman Joe Negron, R-Palm City, said Chief Justice John Roberts's conclusion that the federal government cannot put a "gun to the head" of state health care programs could bode well for the state's other efforts to curb the growth of health care spending. The state is seeking a federal waiver to shift its existing Medicaid patients into managed care.

Negron and his House counterpart, Rep. Matt Hudson, R-Naples, said lawmakers would need to make decisions about the Medicaid expansion during next year's legislative session, when they will have to weigh the influx of federal funds against increased costs to the state. They said the state should be cautious about saddling future Legislatures with new commitments to Medicaid, and that they are unsure Congress will continue to fund the expansion.

"The same folks that are promising an increased federal match haven't passed a budget in three years," Hudson said.

The Washington Post reports that not expanding Medicaid coverage could leave some patients in a coverage gap, because the law may not provide subsidies to make private insurance more affordable for people who would have qualified for the Medicaid.

"This is the perfect opportunity for Florida leaders ... to bring access and good quality health care to people who aren't getting it," said Rep. Mark Pafford, D-West Palm Beach, who sponsored legislation that would have begun to set up health insurance exchanges. "Unfortunately, they're putting politics before people's lives."

The state will also have to decide whether to address other aspects of the law its leaders have refused to implement. A new Medicaid computer system lawmakers approved this year could provide some of the technical infratructure for a state health insurance exchange.

Like other top Republicans, Negron is calling on Congress to pass an alternative health care measure. If that doesn't happen, he said it might be preferable for the state to set up its own health insurance exchange instead of allowing the federal government to intervene.

"I certainly would prefer a state program over Washington setting up cookie-cutter program," he said.

Jennifer Starkey
Executive Director