• Democrats in Congress are poised to start voting this weekend on an inflation deal. 
  • But the deal doesn't expand healthcare coverage for people with incomes close to the poverty level.
  • About 800,000 Floridians will remain uninsured and the next shot at coverage might not be til 2024.

When Democrats in Congress announced last year that they were working on a massive spending bill to transform the social safety net in America, healthcare advocates in Florida were optimistic there might finally be a way to get medical coverage to more people.

Last week, however, their hopes were dashed. One of the many items to hit the cutting room floor in Democrats' compromise $740 billion Inflation Reduction Act was a provision to sidestep Republican state legislators to expand Medicaid to almost 800,000 Floridians.

The omission is a big blow to Florida's uninsured, particularly at a time when many are worried about a recession, and residents already are facing high costs at the grocery store and at the gas pump, as well soaring rental bills, healthcare advocates say.

"It's definitely a missed opportunity, especially if the whole thing centers on inflation and the impacts of inflation," Scott Darius, executive director at the nonprofit advocacy group Florida Voices for Health, told Insider.

Florida is among 12 Republican-led states that refuse to expand Medicaid under the Affordable Care Act, commonly known as Obamacare. Under the law, states pay 10% of costs while the federal government picks up 90% of the tab.

Florida isn't likely to have a shot at expanding Medicaid until 2024 at the earliest. Florida healthcare advocates and Democrats have little faith that Republicans in the state legislature will change their position against Medicaid expansion, so they hope to put the question on a ballot in the 2024 election to have voters weigh in directly. 

"The ballot measure is our best chance of getting Medicaid expansion passed," state Sen. Shevrin Jones, a Miami Gardens Democrat who sits on the state Senate's health policy committee, told Insider. 

"This should be the top priority for us, but the Republicans have shown us time and time again that they are not interested in what makes sense," Jones added. "They are interested in what feeds their base." 

In 2021, President Joe Biden's $1.9 trillion coronavirus rescue package tried to sweeten the Medicaid deal by defraying state costs for two years, but Florida still didn't go for it. Republican Gov. Ron. DeSantis' office told the Washington Post in March 2021 that he "remains opposed to the expansion of Medicaid in Florida."

The governor's office and several other GOP leaders in the state legislature did not respond to Insider's questions about whether any circumstances, such as a recession, could alter their stance on Medicaid expansion. 

Republicans have raised concerns about picking up more healthcare costs, citing fears that the federal government might someday claw back Medicaid payments. 

House Speaker Chris Sprowls, a Republican of Palm Harbor, said he thinks Medicaid should go only toward the most vulnerable residents, rather than be based on income, he told the Orlando Sentinel in March 2021. 

Under Obamacare, people making $13,590 or less for an individual or $27,750 for a family of four qualify to enroll in Medicaid. This raises objections from Republicans given that it doesn't factor in disability or work status.

Rev. Vanessa Tinsley, the executive director of Bridge to Hope, a Miami-based community organization whose services include a food program, said the narrative around people on Medicaid was not true. Many of the client she serves have jobs and college degrees.

"It's not about hard work — we have that here — but they work very hard at low paying jobs," she said, adding that even though Florida raised the minimum wage it hasn't kept up with soaring rents. One big medical issue can evaporate savings or raises, she said. 

Sen. Bernie Sanders (I-VT) (L) walks past Sen. Joe Manchin (D-WV) during a Senate Energy and Natural Resources Committee mark up, on Capitol Hill on May 03, 2022 in Washington, DC. Foto: Kevin Dietsch/Getty Images

US House version of Biden's agenda cut price tag by more than half

For more than a year, Democrats in Congress explored ways to sidestep GOP lawmakers in Medicaid holdout states. An estimated 4 million people nationwide who are uninsured would be able to join Medicaid if all states expanded the program, according to a federal government report compiled by the Department of Health and Human Services.

The US House's $2 trillion Build Back Better Act passed in November 2021 came up with a solution to fill the Medicaid gap. It would have paid the full cost of premiums for private health insurance for people with earnings close to the poverty level.

But the provision was among many stripped out to create the Inflation Reduction Act, though the bill retained other healthcare policies on drug pricing and private health insurance for people with higher incomes who wouldn't qualify for Medicaid. 

The bill could still change. Democratic Sen. Raphael Warnock of Georgia is planning to introduce an amendment to help people who can't access Medicaid. He'll present the amendment during "vote-a-rama," a marathon session of amendment votes that could end up changing the final draft of legislation. The Senate is considering the inflation deal beginning Saturday. 

Florida Voices for Health is working with Southerners for Medicaid Expansion to push Congress this week to support Warnock's amendment. 

But conservative Democratic Sens. Joe Manchin of West Virginia and Kyrsten Sinema of Arizona have been wary about increasing the price tag of the legislation. One estimate from the nonpartisan Congressional Budget Office found the Medicaid idea from the Build Back Better Act could cost the federal government $125 billion. 

Florida Sen. Shevrin Jones debates a bill, dubbed by opponents as the "Don't Say Gay" bill, right before the bill was voted on during a legislative session at the Florida State Capitol, Tuesday, March 8, 2022, in Tallahassee, Florida. Foto: Wilfredo Lee/AP Photo

'We might have to get creative'

Without a federal solution or an immediate ballot vote, the fate of Medicaid is in the hands of state lawmakers or voters.

Tinsley of Bridge to Hope said she was "terrified" of a recession given that she already sees people living on the brink. She knows families whose parents can't get married because otherwise their children wouldn't qualify for Medicaid,  people who skip needed medications, or fathers with asthma who cannot afford health insurance and are left to borrow their children's inhalers. 

"The people in my food line used to be donors and volunteers," Tinsley said. "Our resources are shrinking." 

Not being able to afford healthcare worsens people's circumstance, she said. And many people across Florida who have to cut back on spending can only do so through lowering their grocery bills, she added. Often, less expensive foods are also less healthy, and that leads to problems such as diabetes and high blood pressure that in turn increase people's healthcare bills. 

DeSantis is up for reelection in Florida and is expected to win given that Florida Republicans have out-registered Democrats in the state by 220,000 people. Both Democrats running for the nomination in the August 23 primary to face him — Rep. Charlie Crist and Florida Agriculture Commissioner Nikki Fried — support Medicaid expansion.

Jones faces a primary opponent on August 23. If reelected, he plans to introduce a bill to expand Medicaid, he said. This round, however, he said wants to try to see if there's a way to come to a bipartisan deal as some other GOP-led states have done — particularly after hospitals and health insurers unified behind the effort. 

"We might have to get creative," he said.

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