In the likely final act of one of the most divisive legislative debates in years, the Florida House voted decisively Friday to reject a proposal that would have used federal Medicaid expansion money to help lower-income Floridians purchase private health insurance.
On a 72-41 vote nearly along party lines, the House defeated the bill (SB 2A) creating the Florida Health Insurance Affordability Exchange, or FHIX, after a grueling discussion that lasted almost seven hours. Four Republicans crossed party lines to vote with Democrats.
The plan would have used Medicaid expansion funding from the Affordable Care Act --- commonly known as "Obamacare" --- to help lower-income Floridians purchase private health insurance. Supporters said as many as 800,000 Floridians would meet income limits for health care under the plan, though work requirements likely mean that only 400,000 to 500,000 people would actually be eligible.
Many of the provisions would have to be approved by federal officials.
The bill helped derail this spring's regular legislative session. Lawmakers are now meeting in a special session to resolve health-care issues and a spending plan for the budget year that begins July 1.
"We can say that that issue's off the table now," House Speaker Steve Crisafulli, R-Merritt Island, said after the vote. "And we're here to go put together a budget that's a balanced budget for the state of Florida."
Following the vote, Senate President Andy Gardiner, R-Orlando, issued a statement conceding defeat but saying the end of FHIX meant lawmakers would have to find another way to make up for the loss of hundreds of millions of dollars in funding for health-care providers who treat large numbers of low-income patients.
"While today's debate is over and votes have been cast, the critical health care challenges facing Florida still remain," he said. "This weekend, members of the Legislature will begin a budget conference where we will take hundreds of millions in general revenue that could have been dedicated to schools, roads, our environment or countless other priorities and instead use those limited taxpayer dollars to try to patch together a health care budget that we know we cannot make whole."
In what House officials said was one of the longest debates in recent history, Democrats spent hours pleading with the GOP majority, often emotionally, to approve the measure.
"A vote for FHIX is a vote to say that every single human life has value," said Rep. Mia Jones, D-Jacksonville. "A vote for FHIX allows us to be in the driver's seat, to go to the table, to negotiate and to say what we want to have, what we want to see in place."
Jones was thrust into the unusual role of defending a bill she hadn't crafted and that she and other Democrats said was flawed. No Republican from the House majority could apparently be found to present the measure.
"We want full expansion," said Rep. Reggie Fullwood, D-Jacksonville. "But this is the best plan we've got."
Republicans, though, said that any attempt to differentiate FHIX from Medicaid expansion was a ruse. They pointed out that the plan would use expansion dollars and cover the same lower-income people that were meant to be covered by Medicaid expansion.
"I may be just a simple country lawyer, but I know an entitlement when I see one," said Rep. John Wood, R-Winter Haven. "FHIX is simply Obamacare Medicaid expansion with a clever name."
Rep. Blaise Ingoglia of Spring Hill, who doubles as chairman of the Republican Party of Florida, said the plan relied on flawed expectations. Ingoglia said the federal government would not give Florida permission for parts of the program, such as the work requirement, and could reduce its share of the funding in the future.
"I think the FHIX program should be rebranded as the Wishful Thinking program," Ingoglia said. "Because it is based on a bunch of assumptions that surely will never materialize."
While Friday's vote likely means the end of the discussion of FHIX, the health care debate could continue. House Republicans are looking to revamp insurance coverage for state workers and overhaul some longstanding health-industry regulations. Senate leaders had proposed combining those measures with FHIX in a last-ditch effort to strike a compromise.
And the basic outline of the Senate proposal could emerge again in the future. Senate Appropriations Committee Chairman Tom Lee, R-Brandon, said Friday afternoon that the chamber could bring the measure back up during the 2016 session.
"I've always felt like the problem has to become more troublesome to elected officials than the solution before they ever act," Lee said. "We're not there yet, but we've got a lot of time in the interim to have conversations."