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Thursday Editorial: Floridians want to expand Medicaid — so why aren’t our politicians listening?

One wonders why leaders in the Florida House have been so dead set against expanding Medicaid.

A new poll shows that two-thirds of Florida voters favor it.

The survey was conducted by the University of Maryland between November and January. In four states that didn’t expand Medicaid — also North Carolina, Texas and Virginia — more than 6 in 10 voters supported expansion.

A total of 31 states have passed Medicaid expansion, including such Republican-dominated states as Indiana and Ohio. But 19 states have refused, leaving many of their citizens uninsured.

A total of 13 states won by Donald Trump have expanded Medicaid while 16 expansion states have Republican governors.

The National Governor’s Association (two-thirds are Republicans) reports a “strong bipartisan consensus” to keep Medicaid expansion.

Here are some of the benefits of expansion as outlined in The New England Journal of Medicine:

  • Access to primary care and treatment of chronic conditions have increased. Fewer people are skipping medications.

  • Fewer people are in medical debt.

  • Hospitals have seen a $10 billion drop in charity care.

  • And about 24,000 lives have been saved based on research from the Massachusetts health care reform.

Among the beneficiaries are groups of heavily Trump voters, such as working age adults who do not receive subsidies for Obamacare. Medicaid expansion also provides more funding for mental illness, which is a crisis in Florida.

The opposition of Florida leaders is even more head-scratching since this state already uses market-based systems for Medicaid and has some of the stingiest reimbursements in the nation.


President Harry Truman had a plan.

So did President Richard Nixon.

President Ronald Reagan supported requirements that hospitals must stabilize patients despite an inability to pay.

President Jimmy Carter had a hospital cost containment bill that Congress rejected.

President Bill Clinton’s plan — billed as Hillarycare and crafted largely in secret — was dead on arrival.

President Barack Obama rammed through a plan without a single Republican vote, which was one of its two fatal flaws. The other was a failure to deal adequately with cost.

But the Republican attempt to repeal and replace Obamacare also contains similar fatal flaws

As Jonathan Oberlander wrote in The New England Journal of Medicine, the Republicans pushed without a consensus even among their own ranks.

“But whereas the Clinton plan’s demise dragged on for a year,” he wrote, “Republicans somehow managed to cram legion political mistakes, strategic miscalculations and legislative defeat into just 17 days.”

The bill was too moderate for conservatives, too conservative for moderates and too partisan for Democrats.

And in a Congress not used to reaching compromises on big issues, it was too easy to simply say no.

Leaving Obamacare alone won’t work for Americans, either. Insurers need protection against losing money when there aren’t enough healthy customers to compensate for the sick ones. Subsidies are needed to compensate insurance companies to make up for their losses.

Ensuring the failure of Obamacare isn’t going to do Republicans much good when their party is in power.

What trump voters want

In many cases, Trump voters do not prefer all the choices favored by the typical Republican health care plan.

No, in many cases they would just as soon take something simple like Medicaid.

That’s the conclusion of focus groups held by the Kaiser Family Foundation.

“When you’re on Medicaid, you don’t have to do a complex risk assessment to figure out which plan might be better for you under different circumstances,” wrote Paul Waldman in The Washington Post.

“You just get Medicaid, and when you go to the doctor, it’s paid for. Medicare has some premiums and cost sharing, but compared to private insurance it’s pretty simple and more affordable — which is why it’s so popular.”

Note that people on Social Security Disability are eligible for Medicare, which is commonplace in hard-hit areas like Appalachia.


America is getting older, we know that, but old age isn’t a big driver of higher health care costs, reports a health economist in The New York Times.

The average American lives three years longer than in 1995, nearly 79 years old.

It’s true that those 65 to 74 spend twice as much for health care as working age Americans from 19 to 64.

Those 75 to 84 spend four times as much.

Those 85 and older spend six times as much.

The real cause of the higher spending has more to do with spending near death. Hospital expenses increase by 1,000 percent in the last five years of life.

And that’s one area that needs more examination: the high cost of dying.


Of the 34,000 gun deaths in 2014, more than half were suicides.

Yet both guns and suicide receive far less research funding than deserved.

If gun deaths were researched like other public health issues, there would be $1.4 billion devoted to it, reported Carolyn Johnson in The Washington Post. Instead, just $22 million was spent on it.

“Gun violence is the least researched major cause of death,” she wrote.

Now add the fact that suicide research is underfunded and America has a public health crisis.

For more, visit The Florida Times-Union.

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