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A look at the citizens initiative to expand Medicaid in Florida

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Only 10 states have not expanded Medicaid eligibility under the Affordable Care Act. Florida is one of them. Advocates say that leaves more than a million people in a loophole, earning too much money to qualify for Medicaid and too little for federal insurance subsidies. Now, as Regan McCarthy of member station WFSU reports, people are working around the Republican-controlled legislature to bring the issue to voters with a proposed state constitutional amendment.

REGAN MCCARTHY, BYLINE: The group Florida Decides Healthcare kicked off its campaign on February 1, which just happened to be JJ Holmes' 20th birthday.

J J HOLMES: The best gift I could get is for Florida to expand Medicaid.

MCCARTHY: Holmes has cerebral palsy. He uses an iPad to type out messages with his nose. His mom, Alison, is his full-time caregiver. He needs assistance with everything from eating and drinking to pulling the covers up at night when he gets cold. He says he's worried about his mom, who has arthritis and is almost 60.

J HOLMES: Every day, I try as hard as I can to make it easier for her when she lifts me. But I know I'm hurting her, and I don't know what to do.

MCCARTHY: He has insurance because of his disability, but his mom doesn't. She says she stays awake at night, worrying about what would happen to JJ if she got sick and couldn't afford to go to the doctor.

ALISON HOLMES: My biggest fear is dying from something that would be survivable if I was just able to get typical annual checkups someone of my age gets.

MCCARTHY: Holmes is in a so-called health insurance coverage gap. She has too much income to qualify for Medicaid in Florida but too little to get subsidies from the health insurance marketplace. Without subsidies, an insurance policy could cost someone like Holmes at least $500 a month. She remembers having a health scare a few years ago. She's a U.S. citizen now but came here in 2003 from Scotland, where she could get medical care for free.

A HOLMES: It would have been cheaper for me to fly back to Britain and get checked out over there than to go to a doctor here.

MCCARTHY: Right now in Florida, for most adults and a family of three to get Medicaid, their income must be less than $8,000 a year. But to qualify for subsidies from the insurance marketplace, their annual income must be a minimum of about $26,000.

JAKE FLAHERTY: If you don't fit in those criteria, there's nothing available for you.

MCCARTHY: Jake Flaherty is the campaign director for Florida Decides Healthcare, the group pushing the proposed amendment. He says the aim of the Affordable Care Act, which passed in 2010, was to set up a health insurance exchange where people who didn't have insurance could purchase it. And the ACA would expand who qualifies for Medicaid, which is state- and federally funded insurance for low-income people. But states pushed back, and the U.S. Supreme Court ruled the states could decide whether to expand Medicaid.

FLAHERTY: The ACA was broken. It doesn't work the way it was intended to.

MCCARTHY: Flaherty says the ACA, also referred to as Obamacare, quickly became political.

FLAHERTY: Most states that leaned left or Democratic quickly adopted Medicaid expansion. You did have some moderate and Republican states that got on board, too, just because it made sense and it got people covered. But you had a lot of resistance from folks just on this gut reaction against, you know, quote-unquote, "Obamacare."

MCCARTHY: Recently, North Carolina and South Dakota expanded Medicaid. In Florida, expansion has been a debate for more than a decade. This year Florida Senate President Kathleen Passidomo said it's a nonstarter.

(SOUNDBITE OF ARCHIVED RECORDING)

KATHLEEN PASSIDOMO: Medicaid expansion is not going to happen in Florida.

MCCARTHY: Alison Holmes says after years of waiting for lawmakers to take action, it's time to let the voters decide.

A HOLMES: You feel like you're walking on a tightrope with no safety net underneath, and it wouldn't take much to put that safety net for me and for all the other caregivers in Florida and everybody else who's been left in this limbo.

MCCARTHY: Estimates for the cost to expand Medicaid in Florida differ. Some say it's a major cost, others a significant savings. To get the proposal on the ballot in 2026, organizers have to collect nearly a million petition signatures. Then, once the Florida Supreme Court approves the language of the measure, 60% of voters are needed to amend the Constitution. In every state where Medicaid expansion has gotten on the ballot, it's passed. For NPR News, I'm Regan McCarthy in Tallahassee.

(SOUNDBITE OF J DILLA'S "REQUIEM") Transcript provided by NPR, Copyright NPR.

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Regan McCarthy
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