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Atwater: Medicaid expansion probably won’t pass now, but may be ‘inevitable’ later

Speaking to the Florida Chamber of Commerce on Wednesday, Florida’s Chief Financial Officer Jeff Atwater expressed many of the same concerns of other Cabinet members about Gov. Rick Scott’s proposal to accept federal funding and expand Medicaid: It would grow a government entitlement and be a new billion-dollar expense for the state.

But Atwater seemed to agree with other experts and commentators who believe that Florida and other states will eventually agree to some form of Medicaid expansion, and the billions of federal dollars it will bring. 

Atwater said that the state was in a “really tough spot” because expanding Medicaid will bring additional costs, but not accepting the federal money could have tough consequences as well. Florida’s safety net hospitals will see much of their federal funding evaporate under the Affordable Care Act, and the expansion of Medicaid was supposed to pick up the slack.  The state’s Low Income Pool (LIP) could also face new financial “stresses,” making it difficult for Florida's health care system, said Atwater.

“They may delay this—a ‘No’ is not a ‘No’ forever,” he said. “They can join anytime… I believe they’re going to pass [on the expansion]—that’s my take," he said. "And then I think, as the stresses begin to fall like, again, LIP being diminished, this is going to cause great stress to that choice. And, I don’t know, the inevitable, it may be, no matter what people think, happens.”

Atwater said that he believes the best option is for Florida and the federal government to come up with a more acceptable alternative. A spokesperson for the CFO's office said that Atwater remains opposed to Medicaid expansion.

“I realize where we are. I realize all that’s been said and I realize there’s been elections and there been rulings,” said Atwater. “But I really believe that Florida and other states are going to have to…work with our federal government for real reform of these entitlements.”

Atwater said Medicaid spending has grown from 17 percent of the budget in 2000 to 31 percent of the budget presently and that normal revenue growth would not be enough to keep up with the growing costs.

“Just the growth of the present system is going to either require revenue, or something to change,” Atwater said. “And that’s a really, really tough thing for them to have to face.”

The CFO said that he is concerned with the higher costs associated with expansion, but also worried that the current path—sans expansion—could lead Florida “further down that path.”

House Speaker Will Weatherford, R-Wesley Chapel, spoke out against the Medicaid expansion during a speech opening the legislative session on Monday.

“I am opposed to Medicaid expansion because I believe it crosses the line of the proper role of government,” he said to the Florida House, which officially voted against the expansion on Monday. 

Scott has come out in favor of expanding Medicaid, at least for the first three years while the federal government pays for 100 percent of the cost.

During his State of the State speech Tuesday, he said “I cannot, in good conscience, deny the uninsured access to care,” leading to an awkward situation in which Democrats broke out into raucous applause and Scott’s own caucus sat stone-faced.

A spokesperson for Atwater provided the following statement:

"The CFO does not support the expansion of Medicaid in our state. He believes that the federal government will continue to put financial stress on states that don't expand Medicaid in an attempt to force expansion. Instead Florida should continue to explore financially sustainable alternatives that are centered on the patient and doctor making health care decisions. "