State lawmakers are fighting to stop Medicaid expansion in Florida

After years of rejecting Medicaid expansion in the state Capitol, the Florida House and Senate are trying to block a proposed constitutional amendment that would put the issue before voters.

The House and Senate late Thursday filed briefs at the Florida Supreme Court raising a series of legal objections to a proposed ballot initiative that would require expansion of Medicaid to cover more low-income adults. The briefs argue, in part, that the proposal would be misleading to voters and improperly infringe on the Legislature’s powers.

For example, the briefs contend the proposed amendment would have broader effects than expanding Medicaid to more people. They argue it would effectively force the Legislature to participate in the broader Medicaid program – which is optional for states.

“The Florida Legislature currently chooses to participate in the federal Medicaid program and to appropriate funds to that effect,” the House’s 47-page brief said. “But neither federal law nor the Florida Constitution requires Florida to participate in Medicaid. The initiative proposal removes the Legislature’s discretion to opt out of Medicaid. Instead, it effectively requires the Legislature to enact policies – and to make billions of dollars in appropriations – to allow Florida to continue participating in Medicaid in order to ensure that ‘Medicaid benefits’ are provided to the proposed expansion population.”

The political committee Florida Decides Healthcare is seeking to take the issue to voters after lawmakers have refused repeatedly in recent years to expand Medicaid to low-income adults who currently don’t qualify for coverage. Such an expansion is allowed under the federal Affordable Care Act, better known as Obamacare, with Washington picking up most of the cost for newly covered people.

Florida Decides Healthcare is taking the issue to voters after lawmakers repeatedly refused to expand Medicaid to low-income adults who currently don’t qualify for coverage.

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Florida Decides Healthcare initially sought to put the proposal on the November 2020 ballot but said this summer that it would push back the proposal to 2022. To get the measure on the ballot, the committee will have to submit hundreds of thousands of petition signatures and get the Supreme Court to sign off on the proposed ballot wording.

The proposal, as is contemplated in the Affordable Care Act, would extend coverage to people whose incomes are up to 138 percent of the federal poverty level, the equivalent this year of $35,535 for a family of four, according to federal figures.

Medicaid, which is jointly funded by the federal and state governments, serves about 3.8 million low-income and disabled people in Florida, with the cost expected to be more than $28 billion this year.

The Supreme Court is not supposed to consider the potential merits of proposed constitutional amendments but reviews the wording of ballot titles and summaries to consider whether they meet legal requirements. Those requirements include making sure the proposals would not be misleading to voters and that proposals are limited to single subjects.

The briefs filed by the House and Senate raise a variety of arguments in asking the Supreme Court to reject the ballot proposal. For instance, both contend the proposal violates the single-subject requirement because it would affect multiple branches of government, including the Legislature and the executive branch’s Agency for Health Care Administration.

“The proposal alters the legislative function by establishing a policy decision of statewide significance: the extension of Medicaid coverage to a segment of the working-age, non-disabled, childless adult population,” the House brief said. By mandating the provision of Medicaid benefits, the initiative proposal also significantly alters the role of the Legislature in the appropriations process through removing legislative discretion over the expenditure of nearly one-third of the total state budget. For similar reasons, the initiative proposal substantially alters and performs the functions of the executive branch. The proposal directs in minute detail the specific manner in which the expansion of Medicaid coverage is to be implemented by AHCA, an executive branch agency. And the initiative proposal substantially interferes with the governor’s exercise of the veto power by constitutionally mandating both Florida’s participation in the federal Medicaid program and the expansion of Medicaid benefits.”

With the filing of the opposition briefs Thursday, Florida Decides Healthcare will have time to submit a brief in support of the proposed constitutional amendment. The Supreme Court has not set a date for arguments on the measure.

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