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Sen. Gaetz on Medicaid expansion compromise, the feds, and special session

Senate President Don Gaetz said Tuesday that as the House and Senate work to seek a middle ground on Medicaid expansion the final product that emerges may be a melding of the two extremes that puts Florida at odds with the federal government’s “all or nothing approach.”

“I’m not a lawyer, but our analysis is is that law is not an all or nothing law,’’ Gaetz told reporters Tuesday, after the Senate floor session. “We believe there is and there ought to be flexibility for states to design and implement plans that are not all or nothing.”

He noted that Health and Human Services Secretary Kathleen Sebelius, in her letter to the Centers for Medicaid and Medicare Services “took an all or nothing position” to state’s decision to provide health insurance to low-income Floridians to be in compliance with the Affordable Care Act. In other words, they must accept all federal funds, or reject them all, he said.

“Frankly, we believe there is more flexibility in the law that the secretary thinks there is,” he said. 

Does this mean the Republican-led Legislature is prepared to pass something that could result in a legal conflict with the feds?

The Senate is considering two widely different approaches, both of which will be heard on Wednesday in the Senate HHS Appropriations Subcommittee. One bill is by Senate Appropriations Chairman Joe Negron, R-Stuart, is known as the Healthy Florida program and would draw down $51 million in federal money over the next decade to help qualified low-income Floridians buy health insurance with subsidized “premium assistance.”

The other proposal, by Sen. Aaron Bean, R-Fernandina Beach, rejects any federal money and would instead use state money to help people below 100 percent of the federal poverty level pay for health services. The plan is called the Health Choice Plus program and is similar to a House plan proposed by Rep. Richard Corcoran, R-Trinity, which also rejects federal funds.

Gaetz said Tuesday that while both proposals will get a full hearing in the Senate, “there may be permutations of those options.”

But, he noted, that may set up a conflict with the federal government.

Sebelius “speaks for the administration,’’ Gaetz said. “My guess is CMS works for her. They’re going to listen to them, not me, and I don’t think it should be all or nothing.”

Gaetz has said that he hopes to reach a middle ground that limits premium assistance to certain groups of people that are considered the most vulnerable.

“I think that probably the sweet spot is somewhere near premium assistance for certain groups of people that are the most vulnerable,” Gaetz said.

Gaetz said that he was confident the House and Senate would reach agreement before the end of session on May 3 and dismissed the prospect that they will need a special session to get the work done.

“No I don’t think there’s a strong chance of a special session unless the governor decides to call one,’’ he said. “I don’t think Speaker Weatherford and I believe that there would be any need for a special session. But I certainly hope that we could come to some conclusion on health care coverage issues before the end of the session. We have three ideas, three seriously developed concepts that have been moving through the process.”