By Miriam Harmatz, Alison Yager, and Matt Childers
BACKGROUND ON MEDICAID EXPANSION
The Affordable Care Act (ACA or Obamacare) provided two “paths to coverage” for people with low to moderate incomes. First, people with moderate incomes (100 to 400% of the federal poverty level) could receive subsidies to help pay for insurance in the new Healthcare Marketplace. Second, the law provided that very low-income, uninsured adults between the ages of 19 and 65 would get health care coverage through an expanded Medicaid program, to be largely paid for by the federal government. The expansion extended coverage to adults below 138% of the federal poverty level (FPL) and eliminated Medicaid’s “categorical requirement,” which limited adult coverage to pregnant women, parents and people who were aged, blind or disabled. Although Medicaid expansion was meant to be national in scale, the Supreme Court ruled in 2012 that the federal government could not force states to expand their Medicaid program, but rather expansion must be a state “option.”
STATUS AND IMPACT
Florida is one of only 14 states that have not expanded Medicaid. As a result, approximately 445,000(1) Floridians fall into the “Coverage Gap,” meaning they have no path to affordable coverage. For example, a working parent with one child who earns just $500/month (less than 50% of FPL) is above the income threshold, and therefore ineligible, for Florida’s very limited Medicaid coverage, and at the same time is below the income cut-off for, and therefore unable to purchase, Marketplace coverage. Additionally, approximately 392,000(2) low-income Floridians who do qualify for Marketplace insurance (those between 100 and 138% FPL) are severely burdened by out-of-pocket costs and challenges in accessing care, many of which would be resolved with Medicaid expansion.
A large body of data and evidence show that those states which have chosen to expand Medicaid under the ACA have witnessed improved healthcare access and individual financial stability, as well as economic benefits for states, local communities and providers.
Until Florida expands Medicaid, policy makers and the public must hear from uninsured residents about the suffering and loss that comes with lacking health coverage. The Florida Health Justice Project is working with impacted individuals, advocates and health care providers to help bring these stories to light through our Florida Health Justice STORIES initiative.
1 Garfield, Rachel, Kendal Orgera, and Anthony Damico. 2019. “The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid.” Issue brief. Washington, D.C.: Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.
The changing global climate is already creating far-reaching impacts on population health in Florida that, paired with barriers to affordable healthcare access, will impact Florida’s most vulnerable populations. One particular concern is the increased threat of vector-borne diseases. Thanks to South Florida’s unique environment and status as an international gateway, Florida is particularly vulnerable to vector-borne diseases. The public health impacts of this threat are compounded by the fact that many cannot access affordable health coverage, including over 20% of adult Floridians. This brief explains the increasing threat of vector-borne disease in Florida as a result of the changing climate and the available public-sector responses, including expanding Florida’s Medicaid program under the Affordable Care Act (ACA).
Vector-borne diseases are transmitted through a vector species, such as a mosquito, usually through a bite. Several biological and environmental factors control the transmission and spread of vector-borne diseases. While some factors are capable of human control, Florida also faces major environmental factors, including temperature and rainfall, which impact pathogen infectivity and survival as well vector species breeding. Hurricanes also provide an opportunity for vector-borne diseases to spread—heavy rains, storm surge, and damage create breeding opportunities for disease-carrying mosquitoes.
First, a “thank you”to those responsible for the recent Global Health Equity Symposium at Carrolton School of the Sacred Heart in Miami. They gave everyone present the precious gift of inspiration. Part of the gift was no doubt due to the setting-- an iconic old school on Biscayne Bay where nature and buildings blend to make the other even more beautiful. And “credit where credit’s due:” the Symposium coincided with 3 days of perfect 70 degree weather and brilliant blue sky.
The event began with a documentary about the work of Partners in Health (PIH), Bending the Arc. If you’ve not heard of PIH or the co-founder, Dr. Paul Farmer, and you care about social justice and access to health care, you should read one of Farmer’s books or speeches or, better yet, see the movie. Famer has touched and saved countless lives, helped transform the health care systems of some the world’s poorest nations; co-founded one of the most profoundly positive and impactful non-profits in the history of nonprofits; spoken truth to power. Perhaps most inspiring…. he’s humble and collaborative.
A quick background on how the Symposium happened: Laurie Weiss Nuell, a Miami native whose family has long supported health care equity in Miami and around the world, suggested to Dr. Farmer that he collaborate with Patti Wiesen. Patti is a Carrolton teacher who shares their passion for social justice and imparts it to her students through her art classes, (scroll to bottom of homepage for a short video that tells symposium’s history. http://globalhealthequity.net.)
After the movie, in response to a question about Miami’s health disparities, Dr. Farmer said global health equity is not just about “far away problems;” that working on health justice in the states means focusing on legislation, and that this effort requires some understanding of the economics and financing of health care in America.
So, thank you Dr. Farmer for the perfect segue to a breakout session I led the next day on the moral and economic issues in Florida’s Medicaid expansion debate. Florida is one of 19 states that has still not extended health care coverage to low-income uninsured adults under the Affordable Care Act. As a result, over half a million Floridians have no path to affordable health care and Florida is leaving over $ 5 billion of federal funds per year on the table. We talked about how people (and our local economies) are suffering unnecessarily and how students, faculty and others can work with advocates, including the new Florida Health Justice Project, www.floridahealthjustice.org., on expanding Medicaid.
We talked about how Florida’s Medicaid expansion fight is similar to PIH’s struggle—both are about health care access for poor people who don’t have it. But compared to the monumental efforts of PIH in Haiti, South American and Africa-- where MOUNTAINS have been moved-- the struggle here is like moving a molehill. There are many of us in Florida to move that molehill; we don’t have to get on a plane, we can bend the arc at home.
By Miriam Harmatz, Co-Executive Director
The Florida Health Justice Project, a new nonprofit advocacy organization, seeks to improve access to affordable healthcare for Floridians, with a focus on vulnerable low-income populations.
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