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Jon Greenberg
By Jon Greenberg June 30, 2017
Amy Sherman
By Amy Sherman June 30, 2017

Marco Rubio wrong to conclude that Senate bill won't lead to Medicaid decline in Florida

U.S. Sen. Marco Rubio, R-Fla., says reports that Floridians will be kicked off of Medicaid under the Senate health care bill are misleading.

"As long as Florida keeps the same amount of funding or gets an increase, which is what we are working on, per patient being rewarded for having done the right thing -- there is no reason for anybody to be losing any of their current benefits under Medicaid. None," he said in a Facebook Live on June 28. "In fact, I asked the governor that point-blank, I asked the legislative leaders that point-blank. They have no plans, even if this bill passes, to kick anybody out of current services."

Really -- no reason?

We can’t know for certain what changes Florida will make to its Medicaid program down the road if the Senate bill becomes law.

However, Rubio is making too strong of a vow here that there is no reason for anyone to lose Medicaid benefits.

Here’s what we know: the Senate bill slows the rate of Medicaid dollars that the federal government gives to the states. This will force states to make tough choices, one potential being cutting enrollment. Some of the changes won’t happen for many years, delaying those choices for states.

We contacted Rubio’s office but did not get a reply. (Rubio, who has long criticized Obamacare, hasn’t clearly stated if he will vote for the Senate health care bill. It was unclear as of June 30 when any potential new version would appear and when it would be brought up for a vote.)

CBO and experts predict Medicaid enrollment declines

Medicaid is the health care program for the poor funded by the federal government and the states. Under the Affordable Care Act, about 31 states agreed to financial incentives to expand eligibility for Medicaid. Florida rejected expansion.

Currently about 4.4 million Floridians are on Medicaid or CHIP, a program for children.

The Senate bill also provides additional money that might come to Florida. For states that didn't expand Medicaid, nationwide there would be up to $2 billion a year, and potentially other new funds aimed at hospitals with a high percentage of poor patients.

But the Senate bill takes several steps to restrain future Medicaid spending. While the impact is greater on states that expanded Medicaid by making federal payments less generous, non-expansion states will also take a hit.

The bill ends the open-ended promise for the federal government to cover a certain percentage of a state’s costs. Instead, the bill converts federal Medicaid funding to a per-person cap and limits growth in federal spending beginning in 2020. In 2025, it shifts to a different consumer price index, which has a lower inflation factor than is used today.

That will without a doubt be a lower rate than underlying cost growth, and the gap will grow each year, said Matthew Buettgens, a senior research associate at the Urban Institute.

Medicaid spending goes up whether the current Affordable Care Act remains in place or if the House or Senate versions become law. However, the Republican health care bills slow the rate of spending. The nonpartisan Congressional Budget Office estimated that total Medicaid spending from the Senate bill would be about $770 billion less than under current law over the next decade, leading to an enrollment decline of 15 million.

The Urban Institute estimated the decline in federal dollars and enrollment for the states.

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It found for Florida, that federal funding for Medicaid under ACA would be $16.8 billion in 2022. Under the Senate legislation, it would fall to about $14.6 billion, or a cut of about 13 percent (see table 6). The Urban Institute projects 353,000 fewer people on Medicaid or CHIP in Florida.

The gap in funding is largely driven by enrollment numbers. Under the ACA, the federal government takes steps to actively recruit people to sign up for Medicaid, even in states that didn’t expand the program.

The Republican Senate bill doesn’t have that same goal to spread the word about Medicaid eligibility. In fact, it aims to curtail sign ups. Here are a few ways it sets out to do that:

  • Mandatory six-month eligibility checks that could reduce enrollment

  • Takes away the right of hospitals to make presumptive-eligibility determinations

  • Limits the effective date for retroactive coverage of Medicaid benefits to the month in which the applicant applied (currently it is a three-month window)

There is no doubt that the Senate bill leads to cuts that will affect Florida, said experts on Medicaid spending, including Buettgens; Joan Alker, an expert at Georgetown University McCourt School of Public Policy; and Elizabeth Carpenter, senior vice president at Avalere Health, a consulting group.

Alker said the cap will result in all states making substantial cuts to their Medicaid program. Those would likely be even bigger in the second years after the CBO window.

The cuts will force states to fill the gap in some way that could include any combination of these options: cutting enrollment or benefits, reducing provider payments, cutting other areas of the budget or raising taxes.

"While it is impossible to say exactly what states will do, they will only have bad choices — especially those like Florida that are starting with low per capita spending very much below the national average," Alker said.

Florida would likely reduce monthly payments to health plans leading providers to reduce the number of Medicaid patients they serve or stop serving them all together, said Jeffrey Harman, a professor in the Department of Behavioral Sciences & Social Medicine at Florida State University.

"Recent cuts in Medicaid payments to specialists in Texas has left many Texans that rely on Medicaid without access to specialty care, which can have life and death consequences," Harman said. "I believe similar effects would be seen in Florida."

Rubio said that Scott and legislative leaders told him they won’t cut services, but those decisions will lie with a future governor and legislators years from now.

Other experts pointed us to the Urban Institute’s analysis but we’ll note that a separate group, the liberal Center for American Progress, cited an even higher number by using a different methodology that factored in potential expansion. Rubio challenged the center’s prediction that 1 million Floridians will lose Medicaid by 2026.

Our ruling

Rubio said, "There is no reason for anybody to be losing any of their current benefits under Medicaid."

Rubio is wrong to state that benefit cuts are off the table.

There are reasons that Medicaid recipients could lose benefits if the Senate bill becomes law. The bill curbs the rate of spending by the federal government over the next decade and caps dollar amounts and ultimately reduces the inflation factor. Those changes will put pressure on states to make difficult choices including the possibility of cutting services.

We rate this claim Mostly False.

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"There is no reason for anybody to be losing any of their current benefits under Medicaid."
Wednesday, June 28, 2017

Our Sources

Facebook live, U.S. Sen. Marco Rubio, June 28, 2017

President Donald Trump, Tweet, June 30, 2017

Congressional Budget Office, Cost estimate: Better Care Reconciliation Act of 2017, June 26, 2017

Congressional Budget Office, Medicaid March 2016 baseline, accessed June 26, 2017

Kaiser Family Foundation, Compare Proposals to Replace The Affordable Care Act, June 23, 2017

U.S. Senate, Section by Section summary of the Better Care Reconciliation Act, June 27, 2017

Urban Institute, State by state coverage and government spending implications of the Better Care Reconciliation Act, June, 2017

Avalere Health press release, "Senate Health Bill to Reduce Federal Medicaid Funding to States," June 28, 2017

Center for American Progress, Coverage Losses by State for the Senate Health Care Repeal Bill, June 27, 2017

Miami Herald, "Medicaid spending caps in GOP health plan could be costly for Florida," experts say March 7,  2017

Washington Post, "PowerPost: McConnell is trying to revise the Senate health-care bill by Friday," June 29, 2017

Naked Politics, "Rubio reviews Senate healthcare bill while protesters ask him to oppose it," June 26, 2017

PolitiFact, "Gov. Rick Scott shifts again on Medicaid expansion," April 7, 2015

PolitiFact, "Kellyanne Conway's Mostly False claim that GOP bill doesn't cut Medicaid," June 26, 2017

PolitiFact, "Newt Gingrich misleads with point that House health care bill grows Medicaid spending," June 28, 2017

PolitiFact, "Toomey ‘conflates two things’ in latest health care claim," June 27, 2017

PolitiFact, U.S. Sen. Marco Rubio’s Truth-O-Meter, Accessed June 30, 2017

Interview, Matthew Buettgens, senior research analyst in the Health Policy Center at the Urban Institute, June 29, 2017

Interview, Elizabeth Carpenter, Senior Vice President Avalere Health, June 29, 2017

Interview, Joan Alker, Georgetown University public policy professor and executive director of the Center for Children and Families, June 29, 2017

Interview, Project HOPE senior fellow and economist Gail Wilensky, a health adviser to President George H.W. Bush, June 29, 2017

Interview, Jeffrey S. Harman, Department of Behavioral Sciences & Social Medicine College of Medicine professor at Florida State University, June 29, 2017

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Marco Rubio wrong to conclude that Senate bill won't lead to Medicaid decline in Florida

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