- The Washington Times - Sunday, May 24, 2015

Florida lawmakers say they’re closer to averting a government shutdown this summer after the Obama administration moved to defuse a health-funding standoff with Republican Gov. Rick Scott that has featured a lawsuit, comparisons to a TV mob family and personal pleas to Congress.

Key players in Tallahassee said the administration sped the path to a state budget pact by late June, even though it proposed a significant cut to the Low Income Pool (LIP), a program that helps Florida hospitals care for the poor and uninsured.

For weeks Mr. Scott harangued the Obama administration and even sued them in federal court, saying it was using Mafia-like tactics to force him to expand Medicaid instead of reauthorizing more than $2 billion in LIP funding. With no end in sight, the governor accused the federal Department of Health and Human Services of holding his state budget hostage as uncertainty over health care left a big hole in the plans.

The administration blinked Thursday, saying it could justify $1 billion for the program in the coming year and $600 million in fiscal 2017, casting it as breathing room for Florida to embrace Medicaid expansion or another system that extends medical coverage to the poor.

While it’s half what Mr. Scott requested, the concession from Washington gives state lawmakers a baseline to work with as they hammer out a spending deal.



“While we are still evaluating the effect of the new LIP funding level, this progress will greatly help the [state] House and Senate finalize allocations and pass a balanced budget that meets the needs of Floridians during the upcoming special session in June,” said House Speaker Steve Crisafulli, a Republican who credited Mr. Scott’s “tenacity” in negotiating with the Centers for Medicare and Medicaid Services (CMS).

The standoff is tied to President Obama’s health care law, which called on states to extend Medicaid benefits to those making up to 138 percent of the federal poverty level. Florida and 20 other states have resisted, even though the federal government picks up all of the tab through 2016 and 90 percent of it by 2020 and beyond.

Mr. Scott once embraced expansion but changed his mind this year, saying Washington can’t be trusted to pay its share. Instead, he insists the LIP program is critical for families and reimburses hospitals for serving illegal immigrants, who do not qualify for Medicaid but cannot be denied care.

The federal government typically picks up 60 percent of LIP costs — the rest falls on state and local sources — so it would pony up roughly $600 billion for the coming fiscal year and about $360 million if the trend holds.

A spokesman for Mr. Scott said the governor is reviewing the letter, which didn’t guarantee LIP funding but offered “preliminary feedback” on Florida’s request given the state’s time constraints.

Susan MacManus, a politics professor at the University of South Florida, said Mr. Scott would likely take the deal because it offers a way out on the budget, even if it’s “more like a Band-Aid” than a permanent fix for state health care funding.

“I do think it’s a way that they can at least sit at the table and get something worked out,” she said.

A few hurdles remain. Republican leaders in the Senate endorsed a form of Medicaid expansion that would use federal funds to help 800,000 Floridians buy private health plans, but the House is staunchly opposed to anything that smells like Obamacare.

Senate President Andy Gardiner, Orlando Republican, told fellow lawmakers in a memo that with LIP on its way out, they should be looking at a long-term solution.

“While we may not agree with every policy decision that comes from the federal government,” he said, “I do agree that coverage, rather than back-end supplemental payments, is a better investment for our taxpayers.”

For its part, CMS reiterated its belief that Obamacare is still the most effective way to connect low-income people with medical care, injecting $2 billion into the state’s hospitals above and beyond what LIP provides.

“We believe that Medicaid expansion, as evidenced by experience in other states, would bring significant benefits to low-income Floridians and the Florida health care system,” Vikki Wachino, CMS’s Medicaid director, wrote to the state’s health care agency.

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