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The perils of Florida’s refusal to expand Medicaid

Charlene Dill is one of an estimated 2,000 people who expected to face dire health issues due to lack of access to care

Photo: , License: N/A

Photo: , License: N/A


Woolrich was aware that Dill was trying to get refills on her medication but not that she had become ill. Dill had been bumped off Medicaid because she was making too much money – an estimated $9,000 a year – and had yet to be able to afford a divorce, which might have bettered her chances. A message to Woolrich from a distant relative confirmed that Dill would not be showing up that Friday because she had passed away, but even that might not have happened if Dill’s cell phone hadn’t lit up while she lay prostrate on that Kissimmee floor. The people to whom Dill was peddling vacuums noticed the phone and called her relatives, says Woolrich, telling them, “There’s a girl lying on our floor. We don’t know who she is.”

These are the people in the coverage gap – the unknowns, the single mothers, the not-quite-retired – the unnamed 750,000 Floridians who are suffering while legislators in Tallahassee refuse to address the issue in this year’s legislative session, which ends on May 2. The working poor – who used to be the middle class – are on a crash course with disaster for no logical reason. Charlene Dill, at the age of 32, didn’t have to die.

On April 1, President Obama held a press conference to announce the remarkable success of the Affordable Care Act, despite early indications that the website hosting the federal health care exchange was going to be an obstacle to signing up. Seven million people enrolled in the program, surpassing the expectations of the Congressional Budget Office – and those of most Republicans who oppose the program. In reality, more than double that number have been positively affected by the ACA’s enactment. Those who were automatically enrolled in Medicaid in the states that accepted the federal government’s funding for the program – 100 percent for the first three years, then 90 percent for the fourth year – are not even included in that number. Florida, it should be noted, was second in the number of enrollees through March 31, even without the Medicaid expansion.

In the Sunshine State, 440,000 people signed up on the health care exchange, while 125,000 were judged to be eligible for Medicaid. Florida, with its retirees and low-wage workers, is on the demand side of health care.

“We are No. 2, plus we have a federal exchange,” SEIU state council president Monica Russo says. “I find that quite a statement. Floridians need health care. I think [Republicans] can campaign all they want against health care, but at the end of the day, what are they going to do? Rip health care out of their hands?”

The ACA issue has frustrated the Florida Legislature and governor’s office since the inception of the plan. Attorney General Pam Bondi – following in the footsteps of her predecessor Bill McCollum – actively litigated against the constitutionality of a health care “mandate” along with other Republican states, before those complaints were silenced by that 2012 Supreme Court ruling. Gov. Rick Scott came out in advance of last year’s legislative session with tepid support for accepting Medicaid expansion in light of his mother’s death and the fact that, as he said, nobody should be without health care.

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