Florida Deal Would Reverse Key Part of Obama’s Medicaid Expansion

Mr. Scott welcomed the tentative agreement as one of the first examples of the new freedom and flexibility promised to states by the Trump administration.

“Florida was on the front line of fighting against federal overreach under President Obama,” he said, “and it is refreshing to now have a federal government that treats us fairly and does not attempt to coerce us into expanding Medicaid.”

Trump administration officials say that the expansion of Medicaid under the Affordable Care Act was not a good use of taxpayer dollars and that there are better ways to provide health care for low-income people. But former Obama administration officials said the Trump administration’s change on low-income pools was misguided.

“Florida is just being paid by taxpayers not to expand Medicaid,” said Andrew M. Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services from March 2015 to January of this year. “The low-income pool is essentially a slush fund,” Mr. Slavitt said, “and it’s a really inefficient way to pay for medical care.”

Jessica Schubel, who worked at the Medicaid agency under President Barack Obama, said the action planned by the Trump administration was “a sharp departure from principles that the Centers for Medicare and Medicaid Services” had been following.

In a letter to Florida’s top Medicaid official in May 2015, the Obama administration said: “Coverage is the best way to secure affordable access to health care for low-income individuals. Uncompensated care pool funding should not pay for costs that would be paid for in a Medicaid expansion.”

Florida is one of 19 states that have not expanded Medicaid under the Affordable Care Act. In a report last week, the Urban Institute estimated that 730,000 to 900,000 people would gain coverage if Florida expanded Medicaid. Of the 20 million people insured as a result of the Affordable Care Act, more than half have gained coverage through the expansion of Medicaid.

The Trump administration supports a House Republican bill that would repeal major provisions of the 2010 health law and eliminate funds for the expansion of Medicaid. The Congressional Budget Office estimates that the House repeal bill would reduce Medicaid spending by $839 billion in the coming decade, compared with the amount that would be spent under current law. Fourteen million fewer people would be covered by Medicaid, the office says.

Tom Price, the secretary of health and human services, has said that Medicaid has “real problems,” asserting, for instance, that one-third of doctors in the United States do not take Medicaid patients. At a recent town hall forum on CNN, Mr. Price was confronted by a cancer survivor who said he was alive because of the expansion of Medicaid. Mr. Price said the man’s experience was…

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