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Medicaid in Florida: Take the $50 billion

The refusal by the Legislature to expand Medicaid under the Affordable Care Act has left roughly 1 million Floridians without coverage who otherwise would have had it — a decision that's bad for their health and the state's as well.

The federal government's offer to pay 100% of the expansion for the first three years would amount to an estimated $5 billion a year, nearly $50 billion over the next decade, with the state paying a portion not to exceed 10%.

Moreover, because the feds would also pick up the costs for Florida's Medically Needy program, which provides cost-sharing assistance to people whose income exceeds the Medicaid cutoff, the state would save an additional $430 million. Those savings mean that it would "actually cost the state less to cover 1 million uninsured low-income Floridians than it would to leave them uninsured," according to Health News Florida.

Even if the federal government decides to scale back its matching payments to the program over time, as House Speaker Will Weatherford and other opponents have warned could happen, Florida could pull out and drop expanded coverage at any time, without penalty.

Stonewalling Medicaid expansion, meanwhile, leaves the state's hospitals, businesses and taxpayers to foot the medical bills for the state's 3.8 million uninsured. Florida hospitals provide about $2.8 billion in uncompensated care when people come into emergency rooms without health insurance — costs that are shifted to those with private insurance in terms of high premiums.

"The health system, when it doesn't receive appropriate funding on any of its product lines, it shifts that cost to those people paying the bill," says Patrick Geraghty, chairman and CEO of Florida Blue. "Business pays the bill, year in, year out. If Medicaid is underfunded, business will pick up that expense."