Florida Medicaid fight hits Capitol

Congressional Republicans are stepping up their role in the fight over whether the Obama administration is forcing states to expand Medicaid under ObamaCare. 

Florida Gov. Rick Scott sued the administration last month over what he calls an effort to coerce his state into expanding Medicaid by withholding federal funds for a separate program, called the low-income pool (LIP), that reimburses hospitals for treating the uninsured. 

{mosads}Now the effort is spilling into Congress. After Scott visited Capitol Hill on Tuesday, the House Energy and Commerce Committee announced it will hold a hearing into the alleged coercion this summer. 

Members are also working on a letter to President Obama. 

“What I’ve been asking for is, I’d like them to consider putting out statements, making phone calls, writing letters,” Scott told reporters amid his series of meetings with Republican members of the Florida delegation, as well as prominent Republicans like Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and Senate Majority Leader Mitch McConnell (R-Ky.). 

Scott said the delegation was “very supportive.”

“I told him we were going to stay strong on this and keep pressure on CMS,” said Rep. Ted Yoho (R-Fla.), referring to the administration’s Centers for Medicare and Medicaid Services. “It’s coercion in its worst form and I’m proud of Governor Scott.”

Rep. Richard Nugent (R-Fla.) said that the letter to Obama would point to the harmful effects of ending the LIP funding and say “Hey, listen, these are poor people that you’re holding at bay for a policy decision.”

The administration, for its part, argues that Scott is the one harming poor people by refusing to expand Medicaid. It says giving people Medicaid coverage in the first place is a better system than reimbursing hospitals to cover the uninsured, as the LIP program does.

But it denies that it’s trying to force the state to expand Medicaid, saying that the LIP decision will be made “regardless” of the status of Medicaid expansion.

The CMS has said that the low-income funds should not be used to cover costs that would otherwise be covered by Medicaid expansion. The administration said last week that the state’s $2.2 billion proposal appears too large to meet that requirement. 

Florida Republicans are split over the question of Medicaid expansion, with the state Senate in favor of it and the state House against it. The congressional delegation, likewise, had varying answers on the question. 

Yoho, a strong conservative, rejected the idea. “By expanding it you’re increasing the breadth of the Affordable Care Act,” he said. 

Nugent left the question to the state, calling it Scott’s “bailiwick.”

Rep. David Jolly (R-Fla.), though, said he hopes that Scott and the Obama administration continue to negotiate on Medicaid as well as LIP.

“We need to provide healthcare coverage for individuals with low income in the state of Florida, there’s no question,” he said. “And my only position on this is I would hope that our administration in Tallahassee continues to negotiate with the administration up here, and reaches a conclusion in time that there’s no lapse in funding.”

Scott on Wednesday released a letter to Health and Human Services Secretary Sylvia Mathews Burwell, in which he asks about the administration’s position on possible compromises out of the situation. 

One idea he raised was having the federal government give Florida a block grant that would allow the state decide how to spend the money to expand coverage. “I would like to hear the administration’s answer to that,” Jolly noted. 

Scott also raised the idea of expanding eligibility for the ObamaCare exchange in Florida so that people would buy private insurance, with no state funds at stake, instead of expanding Medicaid. 

The Health Department declined to comment on Scott’s proposal on Wednesday.

Charlene Frizzera, a longtime CMS official who was acting administrator at the start of the Obama presidency, said that the administration is using the LIP funds as “leverage” on Medicaid expansion. 

But she pointed out that it’s entitled to do so, because the LIP funds are part of a temporary waiver given to Florida that is expiring at the end of June that the White House is under no obligation to continue. 

“The administration uses those waivers to forward their agenda,” she said.

While not specifically about the Florida situation, the nonpartisan Government Accountability Office released a report, at the request of congressional Republicans, on Wednesday saying that the basis for spending decisions under HHS waiver programs in general “are not transparent to Congress, states, or the public.”

HHS largely concurred with the recommendation to clarify its criteria.  

The Republican governors of Texas and Kansas, which are also at risk of losing temporary federal healthcare funds, have also backed Florida’s lawsuit. 

“For sure, states that haven’t followed the administration’s agenda, they should be worried,” Frizzera said. 

Meanwhile, hospitals are worried that they might be left without Medicaid expansion or the separate federal funds in some states. 

“We have to reach a resolution,” Jolly said. “Should LIP expire, it would be catastrophic.”