Manchin’s inflation cut health insurance subsidies for low-income people

• Democrats in Congress are set to vote this weekend on inflation.
• But the deal does not extend health care coverage to people with incomes close to the poverty level.
• Nearly 800,000 Floridians remain uninsured and the next coverage may not be available until 2024.

When Democrats in Congress announced last year that they were working on a major spending bill to overhaul America’s social safety net, health care advocates in Florida were hopeful that there might finally be a way for more people to get medical coverage.

Last week, however, their hopes dimmed. Among the many items to hit the chopping block in the Democrats’ $740 billion inflation-reduction bill was a proposal to sideline Republican state lawmakers to expand Medicaid to 800,000 Floridians.

The omission is a big blow to Florida’s uninsured, especially at a time when many are worried about the economic downturn, and residents are already facing higher costs at the grocery and gas pumps, as well as rising rent bills, health care advocates say.

“It’s really a missed opportunity, especially if the whole thing is focused on inflation and inflation,” Scott Darius, executive director of the nonprofit advocacy group Florida Voices for Health, told Insider.

Florida is among 12 Republican-led states to expand Medicaid through 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 doesn’t have a shot at expanding Medicaid until 2024. Florida health care advocates and Democrats have little faith that Republicans in the state Legislature will change their stance on Medicaid expansion, so they hope to put the question on the ballot so voters can weigh in directly in the 2024 election.

State Sen. Shevrin Jones, a Miami Gardens Democrat who sits on the state Senate Health Policy Committee, told Insider that “the ballot measure is our best chance to get a Medicaid expansion mechanism.”

“This is a priority for us, but the Republicans have shown us time and time again that they are not interested in something meaningful,” Jones added. “They’re interested in what feeds their base.”

In the year President Joe Biden’s $1.9 trillion coronavirus relief package in 2021 has tried to sweeten the Medicaid deal by slashing state spending for two years, but Florida still won’t budge. Republican Gov. Ron. DeSantis’ office told The Washington Post in March 2021, “He opposes Medicaid expansion in Florida.

The governor’s office and several other GOP leaders did not respond to Insider’s questions about whether any factors, such as a failure in the state legislature, could change their position on Medicaid expansion.

Republicans have raised concerns about taking on more health care costs, citing concerns that the federal government could one day scale back Medicaid payments.

House Speaker Chris Sproles, a Palm Harbor Republican, told the Orlando Sentinel in March 2021 that he thinks Medicaid should go to the most vulnerable residents instead of being based on income.

Under Obamacare, people earning $13,590 or less for an individual or $27,750 for a family of four are eligible to enroll in Medicaid. This raises objections from Republicans, who assume that it has no effect on disability or working conditions.

The Rev. Vanessa Tinsley, executive director of Bridge to Hope, a Miami-based community organization whose services include a food program, said the narrative surrounding people on Medicaid is not true. Many of the clients you serve have jobs and college degrees.

“It’s not about hard work – we have it here – but they work very hard in low-paying jobs, even though Florida raised the minimum wage, it didn’t go along with the rent increases,” she said. A major medical issue can evaporate or increase savings, she said.

Kevin Dietsch/Getty Images

The House version of Biden’s agenda has cut the price tag by more than half

For more than a year, Democrats in Congress have explored ways to sideline GOP lawmakers in states that already have Medicaid. An estimated 4 million uninsured people nationwide could join Medicaid if all states expanded the program, according to a federal report compiled by the Department of Health and Human Services.

The $2 trillion Building Back Better Act passed in November 2021 offers a solution to fill the Medicaid gap. It would cover the full cost of private health insurance premiums for people with incomes close to the poverty level.

But the provision was among those excluded from creating the inflation-reduction legislation, even though the bill would have preserved other health care policies on drug prices and those ineligible for Medicaid for high-income people.

The bill is still subject to change. Georgia Democratic Sen. Raphael Warnock plans to introduce reforms to help people who can’t afford Medicaid. He will introduce the amendment during a “vote-a-rama” marathon of amendment votes that could change the final bill. The Senate has been deliberating on inflation since Saturday.

Florida Voices for Health is working with Southern Residents for Medicaid Expansion to push Congress to support Warnock’s amendment this week.

But conservative Democrats Sens. Joe Manchin of West Virginia and Kirsten Sinema of Arizona are wary of raising the bill’s price tag. One estimate from the nonpartisan Congressional Budget Office found that better legislation behind the Medicaid proposal could cost the federal government $125 billion.

Wilfred Lee/AP Photo

‘We may have to create’

Without a federal solution or an immediate ballot measure, Medicaid’s fate rests in the hands of state lawmakers or voters.

Hope Tinsley of Bridge Two said she was “frightened” by her failure to see people living on the brink before. She knows families whose parents can’t marry because their children won’t qualify for Medicaid, people who skip needed medications, or fathers with asthma who can’t afford health insurance and end up borrowing their children’s ventilators.

“The people in my food line were donors and volunteers,” says Tinsley. “Our resources are shrinking.”

Not being able to afford health care makes things worse for people, she said. And many people in Florida need to cut costs just by cutting their grocery bills, she added. Often, inexpensive foods are also unhealthy, and this leads to problems like diabetes and high blood pressure, which add to people’s health care bills.

DeSantis is up for re-election in Florida and is expected to win. Both Democrats The candidates vying to face him in the Aug. 23 primary — Rep. Charlie Crist and Florida Agriculture Commissioner Nikki Fried — support Medicaid expansion.

Jones will face a primary opponent on August 23. If re-elected, he plans to introduce a bill to expand Medicaid, he said. But this round, he said, he wants to try to see if there’s a way to come to a bipartisan agreement, as some other GOP-led states have done — especially with hospitals and health insurers uniting behind the effort.

“We might have to get creative,” he said.