TALLAHASSEE — It was “the elephant in the room” that almost nobody wanted to talk about.

Instead of accepting the $4 billion to $5 billion in federal money that would come with Medicaid expansion in Florida, Republican leaders are pursuing a plan to spend nearly $900 million in state taxpayer and federal trust fund dollars to make medical care more accessible by increasing the health care workforce, building clinics and other means.

Some Democrats do support the measure, as it was approved unanimously at its first Senate committee hearing Tuesday.

Sen. Tracie Davis, D-Jacksonville, was the only one to raise concerns about the GOP leadership’s nine-year refusal to expand Medicaid, what she called “the elephant in the room.”

“So, if we are talking about workforce growth, how do we not include the expansion of Medicaid here and what we’re trying to do?” Davis asked Sen. Colleen Burton, R-Lakeland, and chair of the Senate Committee on Health Policy.

Burton, the bill’s sponsor, replied that the expansion of Medicaid would have to be a standalone bill, before moving on. No such bill has been filed.

The debate comes as Floridians have been forced off Medicaid as a COVID-19 provision expanding coverage has expired. The state has already dropped 500,000 people from Medicaid and is reviewing an additional 1.5 million for disqualification.

But GOP leaders aren’t talking about expanding Medicaid to make sure those millions who were added to the rolls during the pandemic continue to have health insurance.

At a news conference last week where the “Live Healthy” bill was rolled out, Senate President Kathleen Passidomo, R-Naples, was blunt about the chances that Florida would ever expand Medicaid.

“Medicaid expansion doesn’t work, and we’re going to take care of everybody,” she said, without providing further explanation. “It’s just a talking point.”

House Democratic Leader Fentrice Driskell of Tampa took exception to that comment.

“We could have heard honest presentations about how many lives and how much money we could have saved if we just accepted Medicaid expansion,” Driskell said. “This is the lowest hanging fruit to improve the health of low-income families.”

Forty other states have accepted Medicaid expansion, which was first offered in 2014 as part of the Affordable Care Act, better known as Obamacare. Of the 10 mostly Southern states that haven’t accepted it, Florida is the largest holdout.

“Because of stubborn partisan politics, we are leaving … our hard-earned taxpayer dollars in D.C.,” Driskell said. “That means people cannot see a doctor till they are sick, and can only go to the ER, which means we all pay for it.”

A workforce bill

Burton and Passidomo see investing in new doctors as the key to making health care more accessible to all Floridians.

“It’s not about whether or not you have insurance,” Passidomo said. “If we don’t have enough people to see you, it’s not going to make a difference.”

Florida is growing by about 300,000 people a year, Burton said. But those new residents don’t bring their doctors with them, she added.

“Most people who have heard about Live Healthy think it’s a workforce bill,” Burton said. “We are going to grow our own.”

Florida is among the most chronically underinsured states in the nation, with more than 11% going without insurance at all, according to the U.S. Census Bureau.

Under Medicaid expansion, a family or person at 138% or below the poverty level would qualify for Medicaid based only on income.

Accepting Medicaid expansion would give the state up to $5 billion in federal money to add 1.5 million more people to the 4.5 million in Florida already receiving Medicaid, according to Healthinsurance.org, an independent guide for the Affordable Care Act and health insurance marketplace.

The state would have to come up with at least $400 million in matching money to expand Medicaid, one of the major complaints the GOP has about it.  But in the long run, the state would save about $200 million a year in taxes, according to the Florida Policy Institute, a progressive think tank.

The state also would have access to $2.8 billion in American Rescue Plan funds if it expands Medicaid.

Meanwhile, the “Live Healthy” plan taps $258 million in state and federal funds to raise the reimbursement rates for health workers.

Obamacare’s successes

Republicans also have resisted expanding Medicaid because it was considered key to the success of Obamacare. Years later, the states that have expanded Medicaid have seen positive results.

Medical debt decreased by 44% between 2013 and 2020 in states that expanded Medicaid in 2014, compared to a 10% decrease in non-expansion states, according to the Center on  Budget and Policy Policies.

Its research shows that state costs of expanding coverage are largely or fully offset by savings in uncompensated care and other areas. Expanding coverage increases the use of preventive care and reduces the need for emergency care.

Yet Gov. Ron DeSantis, Donald Trump and other candidates running for the Republican presidential nomination are still calling for the repeal of Obamacare.

“What I think they’re going to need to do is have a plan that will supersede Obamacare, that will lower prices for people so that they can afford health care while also making sure that people will preexisting conditions are protected,” DeSantis said on “Meet the Press” recently.

State Rep. Joel Rudman, a physician from Navarre, broke ranks with fellow Republicans earlier this year when he said removing hundreds of thousands from Medicaid underscores the need to expand Medicaid in Florida.

Rudman said it would cut down on the number of people seeking treatment at hospital emergency rooms.

“It’s not that these people are dying on the street, it’s that they’re costing us more money by showing up in the emergency room because they do not have access to a primary care physician,” Rudman told Florida Politics recently.

Live Healthy details

Live Healthy is a “robust package of policy enhancements and strategic investments that will help make sure Florida’s health care workforce is growing at the same pace as the rest of our great state,” Passidomo said.

Three main goals are to offer new opportunities for training, education and retention of health care workers;  remove regulatory barriers to increase workforce mobility; and expand the availability of efficient quality healthcare for all Floridians.

The plan includes tuition reimbursements for physicians, nurses and other healthcare professionals, creating a healthcare screening portal, expanding rural care and free and charity clinics, and expanding telehealth.

The plan also expands the role of medical school graduates who have passed the licensing exam and are waiting to be placed in a residency, and reducing barriers for autonomous nurse midwives, while ensuring quality care for mothers and babies, Passidomo said.

Burton said the Live Healthy plan also has a plan to steer people away from emergency rooms.

“This is my 22nd session in the Legislature and I have never seen a bill that has such dramatic changes and advancements” to health care, said Sen. Gayle Harrell,  R-Stuart, a committee member. “This is a game changer.”