Sen. John McCain's surgery has delayed the Senate's expected vote this week on a revised plan to repeal and replace the Affordable Care Act, but the additional time will not improve the Republicans' proposal. Even with the latest changes, the legislation would slash Medicaid spending, offer false hope with cheap insurance that covers little and cost millions of Americans their health coverage. When even Gov. Rick Scott raises concerns, it's clear this approach still needs work.
Scott is a longtime critic of the Affordable Care Act, and he wants Washington to give Florida more control over how it spends Medicaid money. The revised Senate legislation still cuts projected Medicaid spending by $772 billion over a decade, and while it would give states more flexibility the governor points out how unfair the funding formula would be to Florida. The legislation would lock in current inequities by setting a limit on how much the federal government would pay for each Medicaid beneficiary, based on past spending patterns. The governor points out that New York, with fewer residents, gets more than $33 billion a year in federal Medicaid money now and Florida gets less than $15 billion a year. The bottom line: Floridians would be permanently cheated.
What Scott didn't say is that Florida has been miserly with its Medicaid program and would pay a heavy price for that. It also would pay a price for Scott's refusal to accept Medicaid expansion money under the Affordable Care Act, which could have provided health coverage to at least another 750,000 Floridians. The revised Senate bill would give states that expanded Medicaid recently more money for each person Medicaid covers. That's great for those states but bad for Florida.
To be fair, there are other tweaks in the Senate bill aimed at helping Florida — and winning the support of Sen. Marco Rubio. About $5 billion has been added in Medicaid money for states that have declared public health emergencies, such as Scott did to combat the Zika virus. Another $45 billion has been added to address the opioid epidemic, which could help Florida. There also is a change in the Medicaid formula to help states such as Florida with a large number of uninsured residents. But that money would go to the hospitals that treat a large number of uninsured patients when the goal should be to insure more residents and help keep them healthy.
If it were possible to make the original Senate bill worse, Majority Leader Mitch McConnell succeeded. He included Sen. Ted Cruz's proposal to allow insurers to offer bare-bones health coverage that would provide far fewer benefits, cap annual payments or deny coverage to patients with a history of pre-existing conditions. That eviscerates some of the best qualities of the Affordable Care Act, which requires a standard set of benefits, bans caps on annual payments and prevents insurers from excluding anyone with pre-existing conditions. The Cruz change is absolutely the wrong approach, because it would appeal to younger, healthier people looking to save money who likely would discover their coverage was limited only after they were hurt or became sick.
At least Scott has raised the issue of fairness in Medicaid payments for Florida. Sen. Bill Nelson joins fellow Democrats in opposing the bill, and he has been to Tampa and elsewhere listening to the accounts of residents who have benefited from the Affordable Care Act and fear losing their coverage. Yet Rubio has sided with McConnell, criticizes independent estimates that the earlier Senate bill could cost up to 1 million Floridians their Medicaid coverage by 2026 and plans to vote to bring the revised Senate bill up for debate. Perhaps if Rubio could find Tampa Bay on a map, reopen his district office and hold a town hall meeting he would understand the real-life consequences of the Senate Republicans' disastrous health care bill and reach a different conclusion.