WASHINGTON – A last-ditch GOP effort to replace Obamacare with a leaner plan and give states more flexibility to implement health coverage would cost Florida billions over the next decade, according to two analyses of the measure.
For now, Sen. Marco Rubio, R-Fla., is giving it a thumbs up.
“I need to see some of the details on how it impacts Florida,” he told reporters on Capitol Hill earlier this week. “But by and large, returning power to the states is something I’ve long believed in. I don’t think you can design a one-size-fits-all system on virtually anything for a country this size and diversity.”
Rubio and the rest of the Senate might never get a chance to vote on the measure crafted by Republicans Lindsey Graham of South Carolina and Bill Cassidy of Louisiana that’s considered a last-ditch effort to toss aside major elements of the Affordable Care Act.
Two Republicans – John McCain of Arizona and Rand Paul of Kentucky – already have said they will not vote for the Graham-Cassidy bill. A third, Susan Collins of Maine, says she is leaning against the legislation. If she becomes a solid “no” in a chamber where Republicans control 52 of the 100 seats it will mean the bill can’t pass. GOP leaders will be reluctant to proceed with a vote knowing they’d lose.
The Graham-Cassidy bill would keep much of the Obamacare tax structure in place, but it would give the money back to the states in the form of block grants so they can design their own health care insurance systems. The bill would end the Obamacare expansion of Medicaid eligibility in 2020 and replace it with per capita block grants to states to address the needs of low income residents.
It also would undo penalties for large employers that fail to offer affordable insurance to workers. Insurance companies still won’t be able to deny coverage based on pre-existing conditions, but states can waive the provision that caps what they can charge. They can also waive certain mandated coverage under Obamacare, such as maternity care, mental health services and hospitalization. And it would leave in place the provision that allows people under age 26 to stay on their parents’ health care plans.
But the bill would end by 2020 subsidies for low- to moderate-income individuals who purchase insurance on their own rather than getting it through an employer or government program.
States that expanded Medicaid, or have more people receiving private insurance subsidies through the Obamacare marketplaces, would see some of that funding shift to other states. Those that didn’t expand Medicaid, or have fewer people getting help through a marketplace, could initially see an increase in funding. But all states would lose money in the long run and during recessions or other times of increased need, according to the left-leaning Center on Budget and Policy Priorities.
Even though it did not expand Medicaid, Florida would lose nearly $7.6 billion from 2020 through 2026. That’s about 9% less of what the state will get under Obamacare, according to an analysis by the non-partisan Kaiser Family Foundation.
That’s a higher loss than the 8% average cut to states nationally largely because so many Floridians – about 1.8 million last year – signed up for health care through the federal exchanges. About 90 percent of those received some sort of federal subsidy.
Another study by Avalere, a health care consultant firm, pegged the loss at a more modest $4 billion through 2026. It said the state would lose $199 billion through 2036 under the bill following a decade of no Medicare funding from Washington.
Analysts conclude millions would lose coverage nationally under the Graham-Cassidy bill.
Cassidy said the measure would help people in states that chose not to expand Medicaid, including Florida, and give them more tools to design a program suited to constituents as opposed to what they consider a far too rigid, centralized system now under Obamacare.
But Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute, said states already have the options of seeking waivers to the law. What awaits them under the Graham-Cassidy bill is far worse, she said.“The flexibility states will be given under the bill is where to cut, how much to cut and who to cut,” Corlette said “You can’t take that much money out of the system and expect more people to continue to get affordable coverage. It just doesn’t add up.”
Irma gives Rubio, Nelson chance to grow partnership
Maybe they should get a room.
The bromance between Florida’s two senators – Democrat Bill Nelson and Republican Marco Rubio – was already in full bloom before Hurricane Irma struck Florida. At least as much as two senators from different parties can be chummy in the partisan atmosphere of Capitol Hill.
Nelson and Rubio stuck up for each other during last year’s acrimonious fight over Zika funding. And the two have teamed up on tough sanctions against Venezuela this summer. They and their staffs cooperate on judicial appointments, service academy nominations and issues important to the state such as assistance for the elderly and the space industry.
After Irma walloped the state earlier this month, the two were nearly inseparable: serving meals together in the Glades, in a helicopter flying over the Keys, touring ravaged citrus groves in central Florida. They’ve also been teaming up on requests for help from the Trump administration , including one Friday asking FEMA to approve additional Florida counties for temporary roof coverings that allow homeowners to stay in their homes (and avoid motel costs) while they repair their homes.
That’s not to say they agree on many of the most contentious issues roiling through Congress. The Orlando Democrat who turns 75 Friday and the 46-year-old West Miami Republican are frequently on opposite sides when it comes to tax reform, gun control, health care, and federal spending.
But on a personal level, they seem to like each other – at least enough to refrain from the back biting that can permeate Congress.
“Certainly there’s no personal conflict between the two of us,” Nelson once said when asked about their relationship. “We do so much together that you never see that if you didn’t have a good personal relationship, it would be miserable.”
And that could play an important role next year as Nelson runs for re-election against an expected challenge by GOP Gov. Rick Scott. Scott and Rubio are not close to begin with as evidenced by the governor’s embrace of Donald Trump over home state candidates Rubio and Jeb Bush in last year’s presidential campaign.
In a race that’s expected to be close, a tepid endorsement of Scott by Rubio could make a difference in Miami-Dade and other areas of the state where support for Rubio runs strong.
GOP making voter gains, but both parties losing to independents
GOP leaders in Florida are crowing about recent voter registration gains, pointing out that Polk and Volusia counties now boast more Republicans than Democrats.
That means Republicans presently outnumber Democrats in 40 of the state’s 67 counties.
Democrats still hold the edge overall – 4,823,263 to 4,547,933 – thanks to large advantages in population centers, but Republicans have made steady progress narrowing the gap over the past decade.
But the real story may be that both parties are losing ground to voters who simply don’t want to be identified with either major party.
In 2006, Floridians who registered as independent or with a minor party made up 21.8% of the state’s 10,385,606 registered voters, according to Florida Division of Election records. As of Aug. 31, those voters comprised 27% of the 12,845,086 thanks to a more than 1.2 million increase in their ranks over that period.
In addition, 12 counties have more non-major party voters than at least one of the major parties.
Independents and minor party voters outnumber Democrats in Clay, Collier, Lee, Okaloosa, St. John’s, Santa Rosa, and Walton counties. Those voters outnumber Republicans in Broward, Miami-Dade, Orange, Osceola, and Palm Beach counties.
Contact Ledyard King at email@example.com; Twitter: @ledgeking
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