Florida government is very busy. The GOP-dominated Legislature and Governor Ron DeSantis, a Republican darling considered one of the leading contenders for the 2024 presidential nomination, are currently hard at work in a special legislative session, preparing draft law that serve a far-right agenda. On Thursday, for example, they found time to pass a six-week abortion ban.
But since meeting in March, they have done nothing to prevent a possible impending human catastrophe, as hundreds of thousands of the state’s working poor will lose medical coverage over the next year. With the onset of the coronavirus pandemic in 2020, Congress required states not to kick anyone out of Medicaid during the public health emergency and provided additional funding to cover that cost. This requirement ended on March 31, and the additional funding expires at the end of 2023. States now have one year to verify the eligibility of enrollees and remove those no longer eligible. When it’s all over, Florida will be one of the hardest-hit states in the liquidation, with more than 2 million residents at risk of losing Medicaid over the next year.
It’s “a huge deal,” says Erica Li, a health policy analyst at the Florida Policy Institute. “This is the largest coverage transition since the implementation of the ACA.”
A large part of the reason Florida is in this situation is that it is one of 10 states that refused to expand Medicaid under the Affordable Care Act of 2010, leaving those who earn too much enough money to qualify for Medicaid but too little to receive subsidies to buy insurance on the state health care exchange caught in a coverage shortfall. As Florida moves away from pandemic-era emergency coverage, it’s unclear how many Floridians will fall into that gap again, and how many will be able to transition to employer-sponsored health care plans or buy plans on the exchange. Many people who leave the program will be deemed ineligible for Medicaid under the state’s usual requirements, which are among the strictest in the country. For example, an adult with one child is only eligible if they earn less than $7,000 per year. As is the case in a handful of states concentrated in the South, adults in Florida who are not raising children are completely ineligible, no matter how little they earn.
Given these restrictions, it’s no surprise that the majority of Medicaid recipients in Florida are children. Indeed, aAs of August 2022, Medicaid covered three out of seven children in the state. Of course, a lot of DeSantis’ high-profile political goals are supposedly aimed at protecting children. He wants to protect them from learning about racial inequality, the real history of the country, life-saving health care for transgender youth, drag shows and even books about penguins. He even wants to protect embryos and signed the six-week abortion ban late Thursday night.
Yet DeSantis and the Legislature did nothing about the unknown number of children on the verge of losing Medicaid coverage. Although there is no coverage gap for minors and children who are no longer eligible for Medicaid should be able to transition to other federally subsidized children’s healthcare programs, Alison Yager , executive director of the Florida Health Justice Project, said those transfers could take a month or more. Meanwhile, families with children with chronic health conditions will have to float the cost of their medications. Or if a child goes to the emergency room, he will have to hope not to be affected by the bill.
Other children whose parents do not realize that they have lost their coverage will take longer to move on to other care. The Ministry for Children and Families says it has not heard from the 850,000 households it has contacted in an attempt to collect information that could preserve their coverage. Unless they re-establish contact, they will be taken off Medicaid lists, perhaps without them realizing it. Due to such situations, Georgetown University’s Center for Children and Families estimates that “the rate of child uninsurance could easily double, especially in states that don’t take enough time and attention to the process, are less adept at using electronic data sources in their Medicaid eligibility system, and/or have more complicated and expensive public coverage features for children.This describes Florida, where even under the expansion of the he pandemic era, more than 300,000 children remained uninsured.
DeSantis and the Legislature could solve the overall problem by making Medicaid eligibility easier or address it completely by expanding the program to eliminate the coverage gap. And any Medicaid expansion would be primarily funded by federal funds. But, as in other GOP-controlled states, Republicans in Florida have shown no interest in doing so. In fact, the power brokers of the state seem determined to do the opposite. “Some of our elected officials are eager to bring the Medicaid program back to what it was before the pandemic,” says Yager, who points to lawmaker statements supporting that goal. “For elected officials who don’t support an expansive backstop, this can be seen as an opportunity.”
Perhaps the only action Florida leaders appear to have considered is allocating an additional $5.5 million to help staff at a call center for people trying to determine their Medicaid eligibility, Li says. at the Ministry of Children and Families, the understaffed agency tasked with purging the Rouleaux. Li says callers can face hours of waiting.
As he prepares for an expected presidential race, DeSantis has rounded out his resume this spring pushing conservative red meat through the legislature, such as legislation allowing people to carry concealed weapons without a permit. Other bills he hopes to pass and then sign into law this spring would make it harder to register to vote, weaken public sector unions, attack the media, undermine college tenure protections and cut college courses and public universities that explore concepts like white privilege. It plans to criminalize gender-affirming care for minors and even ban teachers from using children’s preferred pronouns. This all comes on the heels of his eye-catching legislation that blocked teaching about gender identity and sexuality from kindergarten through third grade — a pending bill will extend the law to eighth grade — and his Stop Act. WOKE, which banned discussions of white privilege and affirmative action in schools and workplaces.
The DeSantis program is a stark example of the nationalization of state governance. In recent years, as national politics have come to dominate national and local elections, local concerns have been subsumed into the polarized drama of the moment. In that mold, DeSantis, rather than addressing the real needs of his constituents on issues such as health care, used his time as governor to garner national media attention with far-right policies that are based on national infatuations. (He likes to brag that “the Free State of Florida” is “the place revival will die.”) Meanwhile, he does nothing to help the millions of Floridians who will lose medical coverage or be forced to spend next year navigate a difficult transition and overburdened bureaucracy.
This is not the price of freedom. It is the result of politics.