Why Expanding Medicaid Eligibility Could Help Florida Insure More People And Boost COVID-19 Vaccination Rates
Florida is one of a dozen states that has not accepted federal funding in order to expand who qualifies for Medicaid, the program that provides health insurance for low-income Americans.
The $1.9 trillion dollar relief package signed recently by President Joe Biden offers holdout states like Florida more money for Medicaid expansion. Now it’s up to lawmakers in Tallahassee to bring a bill to the floor for discussion and vote on it.
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Opponents in state government say more people on Medicaid costs too much for the state. But according to the Kaiser Family Foundation, the federal government would pay 90% of the bill — that used to be 100%.
WLRN’s Verónica Zaragovia spoke with Alison Yager, the new executive director of the Florida Health Justice Project, and with Zinzi Bailey, a board member of the FHJP and a research professor at the University of Miami who studies health disparities and is a social epidemiologist, about why they want lawmakers to do it.
WLRN: Alison Yager, in the U.S., we're down to 12 states that do not have an expansion of Medicaid eligibility under the Affordable Care Act — that includes Florida. First, can you remind us what that means for Floridians and what it would mean if we did have it?
YAGER: Medicaid expansion is an opportunity that was created by the Affordable Care Act. And the idea was one of the Affordable Care Act's strategies to expand health coverage to as many people as possible. And when states expand Medicaid, what they're doing is raising the income eligibility for those who can qualify for Medicaid. Even before the pandemic in Florida, we already had close to a million Floridians who had no pathway to affordable coverage. And these are low-income parents, older people who do not yet qualify for Medicare, low-wage workers.
Then with the shutdowns of the past year with COVID, hundreds of thousands of Floridians have lost their health insurance, so if we were to expand Medicaid in Florida now, we'd be providing health care coverage to approximately one million, likely well over, one million Floridians. And of course, these economic shutdowns have happened because we're in the midst of a pandemic and in the midst of a pandemic, the health of every individual is truly connected to the health of the entire community. So we're shooting ourselves in the foot if we fail to take every available step to give as many Floridians as possible access to essential health care.
And so how is the Florida Health Justice Project getting your research and your position on Medicaid expansion to lawmakers in Tallahassee?
YAGER: We're sharing stories and and we'll be sharing stories of individuals who are in what we call in the coverage gap, and that means folks who don't qualify for Medicaid [because of their income] and also don't qualify for subsidies under the Affordable Care Act for marketplace insurance. So they're sort of stuck in the middle with no access to affordable coverage.
So we've been collecting stories of individuals in this position. They're up on our website and we've been sharing them via social media and will be doing so again now that we're back in session. I think it's it's really critical when we talk about health policy to remember that these are not just abstract, wonky issues that are debated in the dark corners of government buildings. These are decisions that have very real impacts on people's lives. We want to put those faces front and center.
Right now, we are part of a coalition of groups, being led by Florida Voices for Health and together with allies at Florida Policy Institute and many other organizations around the state, that are pushing really hard for legislators to be taking up this issue and considering all of the benefits that would accrue both to the state residents and to the state budget. These savings come from things like programs like mental health services and substance-use services that currently are being paid for exclusively by the state and which would, with Medicaid expansion, be paid for in very large part by the federal government.
So so we can't wait on Medicaid expansion, both from a public health perspective as well as a fiscal perspective.
Zinzi Bailey, you're working on the issue of unequal vaccination rates in South Florida, especially among black Floridians. How would Medicaid expansion help to bridge that gap if you don't have health care coverage?
BAILEY: Very early in the pandemic, we could see that a lot of our our COVID testing was tied to health systems. You had to go into a hospital to get tested before we had all of the stadiums and other things, other places, that were available for folks to go to or walk-up sites. A lot of people were not going to those sites to get tested because they did not have health care coverage. So they were afraid that they were going to end up with large bills. They did not go to those places unless they were extremely, extremely ill. So what that results in, is somebody actually approaching a health care center very late in their disease progression when they're more likely to have more severe disease, and have come into more contact with people.
So that gap is where people were kind of left out. I think people are seeing the need for health care coverage and a lot of the vulnerability that folks have stems from these systemic inequities in terms of health care coverage.
If you don’t have health care coverage, it is very difficult for you to keep your diabetes under control, for you to know that you have diabetes, for you to keep your hypertension under control — a lot of conditions that would make you at higher risk for death or severe disease from COVID. The same social and structural determinants of health that have put a lot of our Black and Brown communities at higher risk for severe illness are the same ones that drive some of the concerns that people have around the vaccine. Especially among Black and Brown communities that may or may not have access to routine regular primary care or who are seeing the same person over and over again.
I think it's it's really critical when we talk about health policy to remember that these are not just abstract, wonky issues that are debated in the dark corners of government buildings. These are decisions that have very real impacts on people's lives.
If you have HIV, who do you talk to to discuss certain issues? You might want to talk to somebody, a health care professional, before you move forward [with the COVID-19 vaccine]. There may be certain medications you are on that you want to talk to somebody about. I think we need to be doing more on the ground work in terms of answering people's questions about the vaccine. I think it's a great idea to have also maybe a little kiosk, a tent, with people who answer questions.
A lot of them, including myself, are immigrants and we're on WhatsApp. Are there little videos that we can forward to different folks around key information about vaccinations, key questions? Is there a way that we can participate in our church groups? And I would say lastly, as you mentioned about [Dr. Aldo Calvo] who is making himself available at Broward Health, I would say that more [of] that needs to happen.
I see our first responders and our health care professionals as ambassadors for the vaccine, as being people who have kind of the first level of access to the vaccine to be able to say to their communities, "I took this vaccine because of X, Y and Z. I was concerned about Y and I am fine."