It starts like a joke — Gov. Rick Scott walks into a Gainesville Starbucks — but one patron wasn’t laughing.
In town on April 5, 2016, to tour the recently opened factory and headquarters for biopharmaceutical company Nanotherapeutics, Scott stopped in to the coffee chain for a cup. Cara Jennings, a former Lake Worth city commissioner, saw Scott and ripped into him from her seat. Among other grievances, she accused him of denying her health care coverage with his policies.
"In fact, you cut Medicaid so I couldn’t get Obamacare," Jennings shouted on April 5, 2016. "You are an a------! You don’t care about working people. You don’t care about working people. You should be ashamed to show your face around here."
When Scott countered that the state had created a million jobs since the recession, she said no one cared (read our fact-check on those jobs numbers). She then criticized his March signing of a bill denying funding for women’s health care clinics that performed abortions (read our check about that issue).
We tried to reach Jennings by phone, text, email and even Facebook, but we didn’t hear back from her, so we don’t really know the specifics of her situation. That makes it difficult to gauge whether she was able to benefit from the health care law.
But we can look at whether Scott cut Medicaid, the joint state and federal program to provide health insurance for the very poor, in a way that could have denied people health coverage under the Affordable Care Act.
It’s not so much that he cut anything, but more that he hasn’t consistently supported expanding the program. That has indeed left hundreds of thousands of Floridians without coverage.
The expansion debate
Jennings told ABC Action News in Tampa after the incident that she is a single mother who worked part-time. That provides clues that she may fall into what is known as the Medicaid coverage gap.
To understand why, let’s review how the Affordable Care Act is linked to Medicaid.
The law originally wanted to cover uninsured people two different ways. One was to subsidize people who needed help buying insurance through state marketplaces or HealthCare.gov. The second was to expand Medicaid to cover a higher number of poorer people.
Normally, to be eligible for Medicaid, your annual income has to be 44 percent of the federal poverty level (100 percent is currently $11,880 for an individual and $24,300 for a family of four). The plan was to extend that eligibility to all adults up to 138 percent of the poverty level. Technically the calculation under the law is 133 percent, but a 5 percent deduction is added on top of that.
But Medicaid expansion ended up being optional after a 2012 Supreme Court ruling saying it could not be forced upon states. Currently 19 states, including Florida, have chosen not to grow the program.
Recent estimates from the Kaiser Family Foundation showed that 948,000 uninsured adults in Florida would be covered by an expansion. This has led to plenty of debate among lawmakers, including a meltdown during the 2015 Florida legislative session over how to cover more lower-income residents. The Senate was open to a limited expansion, while the House opposed it altogether.
But now the math really starts to get tricky.
If a state doesn’t expand Medicaid, people who make 100 to 400 percent of the poverty level can get marketplace subsidies to buy private insurance. Because of the way the law was written, that leaves people making between 44 and 100 percent of the poverty level out in the cold, without assistance. Those people don’t qualify for Medicaid, and can’t get subsidies to buy insurance.
That’s the so-called coverage gap. According to Kaiser, there are 567,000 people under that umbrella in the Sunshine State.
Chances are good that a single mother working part time could fit into that definition.
Scott, a former hospital chain executive best known for resigning amid controversy over his company defrauding Medicare, has had a spotty history with Medicaid. He initially opposed expanding the program under Obamacare, then supported it during his re-election campaign, then went back to opposing it. We rated his position a Full Flop.
While the Legislature is the body that would have to approve an expansion, Scott’s opinion affects the debate. (Scott’s office did not respond to our questions about Medicaid.)
He has argued with Washington over the federal government ending payments for low-income hospital patients, leaving the Legislature to use state money to plug holes in the program the last two years. Scott has also asked lawmakers to eliminate automatic increases to Medicaid hospital rates.
He’s also overseen the state’s controversial transition to managed care, in which private companies took over Medicaid policies as a cost-cutting measure. Florida CHAIN, a consumer health advocacy group, told us managed care organizations had actually seen a boost in funding.
And there’s the aforementioned abortion bill Scott signed on March 25. That bill prevents state and Medicaid money from going to clinics that perform elective abortions, including Planned Parenthood affiliates.
But these are specific issues not necessarily related to getting access to broad health care coverage under Obamacare. While many Floridians remain uninsured without Medicaid expansion, we found no evidence of an outright cut, as Jennings said.
The activist at Starbucks said Rick Scott "cut Medicaid" so people can't "get Obamacare."
Her point-blank accusation that Scott cut the program doesn’t fit. But through Scott’s inaction and the Florida House's resistance to expansion, many Floridians are not benefitting from either subsidies to buy private insurance or an expanded Medicaid.
The statement is partially accurate but leaves out important details. We rate it Half True.