Now we can have an honest conversation about the costs and benefits of adding more uninsured Floridians to the state’s Medicaid rolls under a provision of the federal health reform law known as Obamacare. For after hyper-inflating the true cost, and getting pushback from legislative budget analysts, Gov. Rick Scott’s administration finally released a more realistic cost estimate for helping poor people get health care. And it’s a shocker. The new pricetag is about a fifth of what the governor has been leading us to believe.

In reality, it would cost Florida about $3 billion over a decade — not $25 billion, as the governor had been saying — to provide access to health care for about 910,000 Floridians. This includes families who live just above the poverty line — $29,326 for a family of four — as well as childless adults who live below the poverty line. As most of us now know, the new Affordable Care Act requires Americans to buy health insurance or pay a penalty. But to help cover the very poor, the law allows for an expansion of Medicaid for states that are willing.

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To encourage state participation, the law says the federal government will pay 100 percent of the costs of new enrollees for three years, tapering down to 90 percent after 2020. But our governor, who rode into office fighting Obamacare and led its unsuccessful legal challenge all the way to the U.S. Supreme Court, doesn’t believe the president and Congress will follow the law. As a result, he’s been trumpeting numbers that suggest Florida would bear the costs of the expansion alone. Even after the revised estimate was released Wednesday night by an agency that reports to him, the governor continued to press his point Thursday during a stop at Fort Lauderdale High School. “We don’t know what the federal government is going to fund,” he insisted. But legislative budget analysts said that legally, they couldn’t accept the governor’s assumptions. Their concerns were found in emails uncovered by Health News Florida, a respected website, after the governor went to Washington and again repeated his deception. Make no mistake, these are still big numbers. And Medicaid already consumes about $22 billion of Florida’s $65 billion budget, though the lion’s share goes to cover elderly people in nursing homes. Whether to expand Medicaid is likely to be the number one issue before the Legislature when it meets in March. Given that fighting Obamacare is the governor’s signature issue, we hold little hope he will change his mind about expanding Medicaid. For in his opposition, he has yet to identify with low-income Floridians who are sick and dying because they cannot afford health insurance or access to health care. But perhaps he would consider a business case for expanding Medicaid and plugging any remaining holes in the requirement that people have health insurance. For if everyone must have health insurance, we could:

• Look at the continued need for special taxing districts, which were set up in yesteryear to fund care for the uninsured.
• Re-examine local sales taxes established in some Florida counties to fund care for the uninsured.
• Consider the $30 billion in federal funds that would come to our hospitals. Indeed, our safety net hospitals call the expansion of Medicaid “an economic boom.” Finally, if for a moment we could take our eye off the bottom line, we could look one another in the eye and agree that providing health care to the poorest among us exemplifies the finest ideals of American exceptionalism.

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