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00000173-d94c-dc06-a17f-ddddb4b10000By Wilson Sayre and Daniel ChangThousands of South Floridians too poor to afford health insurance on their own end up in what is called the "coverage gap." They earn too little to get help buying health insurance under Obamacare, but they don’t qualify for Medicaid.WLRN and the Miami Herald look at what life is like in the coverage gap through the experience of Miami resident Cynthia Louis. Reporters explore how being uninsured affects your life, your health, and your wallet.Need to find low-cost care? The Miami Herald developed a low-cost health care finder. Find help at hrld.us/findcare.

Medicaid: For The Loafer-Wearing Special Interests Or For The Neediest Floridians?

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Wilson Sayre
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WLRN

This is the fourth and final part of our series, Falling Into The Gap, in collaboration with the Miami Herald. Read more about the coverage gap and find affordable care on WLRN.org/healthgap.

Cynthia Louis is a big fan of President Obama. A collage of pictures of the president is propped up against the living room wall along with pictures of her children and a certificate of appreciation from her church.

She hasn’t been such a fan, though, of how Obamacare was rolled out in Florida, leaving her and 850,000 other Floridians in what is called the health care “coverage gap.” They earn too little to get help buying health insurance under the Affordable Care Act but do not qualify for Medicaid.

For the past two years state lawmakers could have changed things for people like Louis, but proposals to cover more people through Medicaid never made it to a vote. This year health care advocates think they have the best shot yet to cover the hundreds of thousands in the state.

Miriam Harmatz is a health law attorney with Florida Legal Services, which advocates for Medicaid expansion.

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Credit Wilson Sayre / WLRN
Cynthia Louis is a big fan of President Obama, but not the way Obamacare was rolled out in Florida.

With 140,000 people in the gap in Miami-Dade County alone, “we are really the most heavily impacted in this debate from every perspective economically and human scale,” says Harmatz. “Our safety net stands to lose the most.”

That safety net includes clinics, hospitals and health centers that treat people like Louis who don’t have insurance. This year, the debate has come to a head because the program that pays for that called the Low Income Pool, or LIP, could go away.

For more than a year, the federal government has said that money will go away on June 30, which would blow a $1.2 billion hole in the state budget.

Senate Plan

Powerful business groups have persuaded senators that insuring the poor is good for business.

Republican Senator Rene Garcia, who has proposed expansion bills in the past, has this year introduced legislation that has gained a lot of traction in the upper house.

In Senate Bill 7044, the “FHIX” plan would create Florida’s own version of Healthcare.gov, a state-run marketplace for people to buy insurance.

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Credit Infographic by Kara Dapena / Miami Herald
There are 28 expansion states (blue) and 22 non-expansion states (red).

Private insurance companies would sell Medicaid plans to low-income Floridians who qualify for help from the government, extending insurance coverage to people who are not covered now.

Included in the plan are some requirements that people either be working or searching for work to get help from the government. When other states have tried similar requirements in their Medicaid expansion plans, the federal government has not allowed it, which has to approve any state-run Medicaid exchange before it releases the roughly $5 billion a year to pay for the program.

Senators have supported this plan every step of the way.  

House Resistance

Despite the bipartisan enthusiasm in the Senate, House leaders say Medicaid is a broken system, and adding more people makes no sense.

House Appropriations Chairman Richard Corcoran has been one of the most vocal opponents against expansion.

“Come to war on health care with us,” invited Corcoran at a House budget committee meeting in early April. “I’ll proudly declare war on all the special interests, all the Gucci loaf[er] shoe wearing special interest powers that be. They’re sitting in that hallway, every single one of them wants Medicaid expansion.”

In the past, the House has been able to just ignore the issue of expanding Medicaid. But this year they can’t because the Florida Senate included funding for the Medicaid expansion plan in its proposed budget. The House did not.

Both sides will have to talk about Medicaid, whether they like it or not. The legislative session is supposed to end on May 1. If they don’t have a budget by then, legislators will have to come back to Tallahassee and keep going.

Meanwhile down in Miami, Cynthia Louis is waiting.

“What about the people that was working,” asks Louis, “and want to work again and need to see the doctor and can’t see the doctor because they ain’t got no insurance? Come on.”

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Credit Infographic by Kara Dapena / Miami Herald

WLRN is a part of Health News Florida, which receives support from the Corporation for Public Broadcasting.