A Massachusetts college professor known as "Mr. Mandate" made the case why the Florida Legislature should embrace the Affordable Care Act. But nearly every point he made was countered by a representative from the conservative Cato Institute that is dead set against the health care law.
The result was a two-hour debate where the speakers agreed on very little, giving senators a lot to think about it as they consider what Florida should do when it comes to the Patient Protection and Affordable Care Act.
Jonathan Gruber, a professor of economics at Massachusetts Institute of Technology, gave an overview of his state's law that provided the model for "Obamacare." A long-time defender of both the Massachusetts and federal health care reforms, he encouraged Florida to embrace "Obamacare" as a way to provide more access to the uninsured and improve their quality of health.
As Gruber encouraged the state to accept billions of federal dollars to expand Medicaid, Cato's director of health policy studies Michael Cannon outlined eight reasons why Florida should not. The government can't avoid it, the system is rife with fraud and inefficiencies and there still aren't enough details on how it should work, Cannon argued. More than once he said the expansion would cost Florida $20 billion in the first 10 years, a number that was questioned, debunked and eventually revised much lower by state economists.(Update: Cannon called us Wednesday night to clarify that the number he was using was not based on the state's $26 billion estimate that was later revised but a different report by a Cato Institute senior fellow, which he stands by. Link here.)
Both men did agree on one thing, although for different reasons. They both argued that Florida should not pursue creating a health exchange, at least initially.
Members of the Senate committee create to study the health care law asked each man questions about the costs and implementation of the law, and their responses provided even more contrasts. For example, Chairman Joe Negron, R-Stuart, said he didn't like hearing Gruber suggest Florida lawmakers should be less concerned about the law's impact on the nation debt.
"In a way, are we accomplices by taking all this free money which isn’t free to the state and then simultaneously saying if we were in Washington we wouldn’t be doing that?" Negron said.
Gruber answered that if the state decides not to expand Medicaid because of these reasons, it would be solving a complicated issue by penalizing the neediest Floridians. "You are essentially saying I’m going to balance the federal deficit on the back of the poorest residents of the state who have no other alternative for their health care,” he said.
Negron also had a tough exchange with Cannon over the options facing Florida families if the state rejects the Medicaid expansion. Where would an insured, poor family have to go if it doesn't get the access to health care coverage?, Negron asked.
Cannon suggested charities could help fill in the gaps, or that the family could scrape up the dollars to purchase a less comprehensive policy with a high deductible.
The Senate committee and its counterpart in the House will come up with recommendations on whether Florida should expand Medicaid in 2014 and if the state should create an exchange. Already the federal government has set it will operate one in Florida since the state missed a deadline to launch one in 2014. The state also has to decide if it will offer insurance to full-time contract employees or pay a hefty fine.