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Florida Children's Health Advocates Ready to Fight for Medicaid Expansion, Again

Khalil Abdullah, Special to the Informer from New America Media | 7/2/2013, 3 p.m.
Courtesy of medicaid.gov

During the heated debate in Florida’s legislature over the expansion of Medicaid, children’s health advocates contend that the precarious status of the state’s uninsured children was slighted.

They vow not to let that happen again.

The legislative session, which ended in May, left the state as one of 20 that decided to forgo increased federal funding. Had the Medicaid expansion been enacted in Tallahassee, it is estimated that more than 1 million Floridians would have been provided access to health care through the $51 billion the state would have received for the program over 10 years.

“The energy was really focused, and rightly so, on Medicaid expansion, but lost in the maze of rhetoric was the importance of getting that passed, not only for low-income individuals and families, but for children,” said Linda Merrell, coordinator of the Florida Child Healthcare Coalition.

This summer, as advocates work on “getting Medicaid expansion back on the table,” she emphasized that time will “be devoted to raising significant awareness that this [Medicaid expansion] is about closing gaps for children as well.”

Despite Gov. Rick Scott’s endorsement of Medicaid expansion after avowing to oppose it, his party’s Republican-dominated Florida House successfully shut down enactment of the law that would have raised the eligibility ceiling for Medicaid for individuals up to 133 percent of the Federal Poverty Level.

One concern voiced by opponents is that the expansion would have allowed single, childless men – a cohort not eligible under the state’s current program – to become covered under the new expansion criteria. Little discourse, however, was directed at the consequences for children in the decision to decline the federal funds.

Florida ranks second in uninsured children

Ranking second in uninsured children, Florida has an estimated 500,000 children, or 12 percent of the state’s population, who are uninsured. The predictable result is that those children receive less primary care and have a higher mortality rate than their insured peers. Taxpayers are paying skyrocketing costs to cover the uncompensated care expenses hospitals incur from attending to the medical needs of children in emergency rooms when their parents cannot afford to pay those bills.

The current situation is an irony not lost on Merrell. Her involvement in children’s issues reaches back to 1998, when Florida was one of three states chosen to launch a federal pilot project for what would become the State Children’s Health Insurance Program (SCHIP), which had been enacted the previous year.

She recalled the federal law as a bipartisan deal successfully brokered by Senators Ted Kennedy, a Democrat, and Utah’s Republican Orrin Hatch. Merrell explained that the current structural complexity of Florida’s children’s health program, now known as Florida KidCare, was also the result of political compromises; each state was allowed to fashion its own version of the law to qualify for federal funds.

Of state versions of SCHIP, Merrell asserted, “We have the most complex law for it in the nation.” She said the program has been administered by four different state agencies which, even when operating with good intentions, are often hamstrung by internal administrative procedures and systems that have yet to be reconciled, although some improvements have been made over time. Merrell argued that one key benefit of Medicaid expansion for children would be leveling of the bureaucratic obstacles of these “stair-steps” as more parents are brought into coverage.