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Nancy Smith

Fix LIP First, Work Out Medicaid Differences Later

April 26, 2015 - 6:00pm

Somebody fish Matt Dillon out of the Long Branch. Right now the Dodge-style shoot-em-up dividing the Florida Legislature on Medicaid expansion could use the gun-toting marshal to restore peace and a little common sense.

Florida needs a take-charge authority in a white hat to insist before anything else -- before another word is said about Medicaid expansion -- lawmakers in the House and Senate fix LIP.

After that, and only after that, they can come back and work out their differences over Medicaid.

In reality, the $2.2 billion in federal funding for LIP is the cause of the budget battle.

LIP is funding that now helps hospitals pay for uncompensated care for low-income and uninsured patients. It's our money. It's funding that mostly has come from Florida taxpayers who already have paid the federal government, and typically the state would get its fair portion back from Washington.

But the Obama administration, through the Centers for Medicare and Medicaid Services (CMS), intends to stop sending it in June.

It's extortion. It's meant to get the state to accept federal money to expand Medicaid to another 800,000 eligible "patients."The feds are withholding billions of dollars in order to force the Legislature and Gov. Rick Scott to play ball with President Obamas drive to expand Medicaid.

Only, we're looking at a shortfall. The money the federal government would "give" Florida for Medicaid expansion wouldn't be enough to cover lost LIP money -- which is a part of the budget in virtually every hospital in the state.

Hooray for Scott, House Speaker Steve Crisafulli and House members generally who are resisting the strong-arm tactics of the Obama-ites. Bad idea for the federal government to play politics with funding for those in need.

Whats of even greater concern, the Florida Insurance Council and other opponents say, is if Washingtons hostage tactics succeed and Florida is forced into expanding Medicaid, "the state will not have any oversight or control over the costs of health services, who receives it, the type of benefits they can receive, and its implementation."

The Florida Chamber of Commerce has long opposed the outright expansion of Medicaid without putting cost control mechanisms in place -- that is, costs from fraud and abuse, meritless lawsuits, and so forth -- and reducing the insurance premiums for those paying for charity health-care. The chamber's sensible Smarter Healthcare Coverage in Florida plan included these components, but the Senates plan did not. Instead, the Senate is steaming full-speed ahead on a plan that may be acceptable to the CMS, but it's unlikely to win the support of a more wary, more conservative House.

CMS should heed Scott's lawsuit and a separate suit filed by the Pacific Legal Foundation and quickly decouple LIP funding from Medicaid expansion. Failure to act quickly, as the Florida Insurance Council points out, "will ... risk creating great collateral damage to the states economy."

We need to get LIP settled into the budget now and revisit Medicaid expansion separately.

Reach Nancy Smith at or at 228-282-2423. Twitter: @NancyLBSmith

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