Florida Gov. Ron DeSantis Keeps making news about his self-described “news” Campaign To fight “woke” ideology. Two weeks ago, the Republican was making headlines. Announcement He had banned public high schools in the United States from offering an Advanced Placement course about African American history. His administration approved the course. explained, “lacks significant educational value.”

While his political supporters were delighted by the announcement, his left-leaning critics were outraged. It’s safe to assume these were precisely the reactions that DeSantis They will raise his profile nationally and increase his chances of winning 2024 Republican Presidential nomination. This, you might have heard, is what he likely seeks.

But DeSantis Other governing duties are also his. One of them is looking out for the health and economic well-being of Florida residents, including those who can’t pay for medical care on their own because they don’t have insurance.

Florida has quite a lot of them ― nearly 2.6 million According to U.S. Census data, 2021 was the latest year. That’s about 12% of its populationIt is also well above the national 8.6% average. It’s also more than all but four other states.

Floridians without insurance suffer because when they can’t pay for their medical care, they end up in debt or go without needed treatment or both. State suffers too because of a less productive and sickly workforce, as well as higher hospital, clinic, and charity care loads.

DeSantis Could do something to change this. He refused. He has refused.

This is a story that deserves national attention.

DeSantis Has The Health Care System: A clear record

The simple, straightforward reason so many Floridians have no health insurance is that its elected officials won’t sign on to the Affordable Care Act’s Medicaid ExpansionThe federal match funds are available for states if the program is made accessible to all income levels below the poverty level.

Most states do this now. It’s the single biggest reason that the uninsured rate nationwide is at a record low. However, eleven The states have refused to sign the Affordable Care Act, leaving the stricter eligibility rules they were using before it took effect.

Florida is among them. Childless adults in the Sunshine State can’t get Medicaid They are not eligible if they have a disability or fall under a different eligibility category. And even adults with kids have a hard time getting onto the program because the standard income guidelines are so low ― about 30% of the poverty line, which last year worked out to less than $7,000 for a family of three. That’s not enough to cover rent, food and other essentials, let alone buy a health insurance policy.

All non-expansion state governors and legislatures are Republican, as is almost every one of them. Deep South. They are the last resistance to be defeated ObamacareRepublicans have spent over a decade fighting it and came so close to repealing it in 2017.

Gov. Ron DeSantisThe photo of a recently visited Daytona Beach show that he didn’t say much about. Medicaid Expansion — Why he is opposed to it

Paul Hennessy/SOPA Images/LightRocket via Getty Images

DeSantis He wasn’t a passive observer to all that was happening. He was a Republican who served in the U.S. House. far-right caucus We voted no to the first ACA repeal bill brought by the leadership. DeSantis and his allies said, it didn’t undo enough of the law’s protections for people with pre-existing conditions.

GOP leaders finally proposed a stronger repeal. DeSantis His colleagues and he voted in favor of that proposal, but it was rejected by Senate.

Now that repeal is off the political agenda the key question regarding the Affordable Care Act will be whether or not states such as Florida will follow all others in opening up their healthcare systems. Medicaid Everybody who lives below the poverty level is eligible to participate in this program.

If so, several hundred thousand Current residents without coverage would get it. eligible Based on independent estimates, the following is the cost of the program.

A Pandemic Relief Effort Has Ended and its Impact

Florida’s refusal to expand Medicaid It is not new. It is now relevant due to an expired federal pandemic rule and its possible effect on low-income residents’ access to healthcare.

The federal government provided additional money for states to help them fund COVID-19 when it was implemented. Medicaid as long as states agreed not to disenroll anybody who joined or was already on the program ― on the theory that in the midst of a public health emergency, the overwhelming priority was maximizing the number of people with insurance.

It is that arrangement It is all about to end. States have one year to complete their Medicaid enrollment files, removing Anybody who can’t reestablish eligibility. And in every state, significant numbers of people are likely to lose coverage ― in some cases simply because they aren’t aware their coverage is in jeopardy or because they can’t make their way through a complex, confusing process their state has put in place.

Some officials in certain states go out of their ways to reduce coverage loss. OregonFor example, we will let all children under 6 years old stay at the house Medicaid automatically. Illinois It is making it more convenient for adults to continue the program, while taking longer to complete the process of reestablishing eligibility.

Florida has just revealed its plans and according to Joan Alker, executive director of Georgetown University’s Center for Children and FamiliesEven though projections are not in its favor, it seems that the state is determined to push ahead. 1.75 million Floridians You could be without insurance.

“They’re very anxious to get almost 2 million people off of Medicaid, which is scary,” Alker spoke to The Sunday Review. She added that she is especially worried about children, who represent a disproportionate number of Florida’s Medicaid Population because income guidelines for young adults are more loose than for adults.

Alker made it clear that Florida’s final handling of the review process was not certain. Medicaid enrollment. She expressed her gratitude that the government had made public statements acknowledging children’s unique situation.

For the spokesperson Florida Policy Institute, a nonprofit organization that has been tracking the state’s plans, offered a similarly mixed assessment ― crediting state officials with an “intentional” plan that stressed communicating with parents clearly about their options while stating that it’s “too soon to tell whether the efforts outlined in the plans will be enough to make sure that Medicaid-eligible Floridians keep their coverage.”

However, Florida officials may decide how to manage this process. And however it turns out, there is one certainty: Florida would be a member of the Medicaid Without expansion, people would lose their health insurance coverage in a much lower rate.

It’s a difficult time for the uninsured in Florida

Frederick Anderson, who is a family physician, understands better than anyone what the impact health insurance has on people living in Florida. Anderson oversees the medical operation at Miami’s clinic that serves underserved patients. One woman is a particular focus of his attention.

She’s the primary caregiver for a son with autism, Anderson told The Sunday Review, and she has no insurance because her below-poverty income is too high for the state’s Medicaid threshold. She’s been suffering from serious, debilitating headaches, but she can’t pay for the MRI she needs or find a neurologist with an open appointment.

It’s a problem he sees all the time, Anderson explained, because there just aren’t enough safety net providers to meet the demand. Many patients end up having to wait for care or skip it entirely. “We do the best we can,” Anderson stated, “but many of our patients will need to see orthopedists, or neurologists or you name it, and these individuals have no easy access to those services. Or they would benefit from certain medications that I would like to prescribe for them, but … it’s just unaffordable.”

Anderson lives and works there Miami-Dade CountyFlorida’s highest uninsured population is in Lee County. Rural areas in Florida are facing unique challenges.

Health care is economic. more difficult For rural hospitals to be able to exist without assistance Medicaid, which is why in states like Florida that haven’t expanded eligibility, rural hospitals are struggling and in some cases closing, depriving communities of more than just acute care.

“We think of hospitals as places to go when you have something major that is wrong,” Scott DariusThe executive director of advocacy group Florida Voices for Health CareThe Sunday Review was told by. “But in those rural areas, we’ve learned, hospitals are the primary care location for large portions of the population.”

DeSantis Hasn’t Had Much To Say On Medicaid

These accounts have a consistent history stories They are heard by reporters who cover health care all the times. Some of their stories echo the anecdotes about an organization known as the Florida Health Justice Project It has collected data on its website in conjunction with advocacy groups for Florida expansion.

“Florida ranks [near the bottom] for the rate of uninsured residents,” Alison YagerThe Sunday Review was informed by a Health Justice project executive director, Dr.. “Expanding Medicaid, as all but 11 of our sister states have done, would surely boost our shameful showing.”

But the cause has been a tough sell in Tallahassee, where Republicans have had nearly uninterrupted control of the Florida’s lawmaking process since 1999. The state legislature had previously failed to approve expansion in two previous attempts. DeSantis’ spokesperson confirmed in 2021 He was opposed.

That was two years ago, and since then he’s managed to avoid saying much about the issue, including to The Sunday Review, despite several inquiries to his office over the past three weeks. Medicaid Expanding was possible only sporadic attention In the 2022 campaign for gubernatorial office, Democrats tried initially to make it an issue, and it didn’t draw so much as a mention in the lone debate DeSantis Having a conversation with the Democratic nominee Charlie Crist.

One year earlier, DeSantis The bill was a bipartisan measure, a smaller one: the 2021 bipartisan bill increasing. Medicaid’s postpartum coverage from 60 days to a year. It was a priority for the outgoing GOP House speaker, and it’s always possible political circumstances will align and lead to more legislation like that in the future.

But DeSantis’ hostility to government health care programs runs deep.

Protesters rally near the U.S. Capitol after House Republicans voted to repeal the Affordable Care Act in 2017. DeSantis was one of those House Republicans.
Protesters gather near the U.S. Capitol following the repeal vote by House Republicans of the Affordable Care Act. DeSantis He was among those House Republicans.

NICHOLAS KAMM/AFP via Getty Images

He was an attacker long before that. “critical race theory” lessons and supposed sexual brainwashing in the schools, he was railing against Obama-era programs generally (as New York magazine’s Jonathan Chait has explained) and the Affordable Care Act specifically (as The New York Times’ Jamelle Bouie (as he wrote) that it was fundamentally inconsistent with American freedom principles and private property rights.

DeSantis Expanding may have additional practical obstacles Medicaid. Perhaps he believes it’s too big a drain on state finances or too wasteful a program, as many conservatives and libertarians argue. Maybe he thinks Medicaid Beneficiaries are more at risk than the program is worth. If beneficiaries were to be more productive and get paid jobs, they could still find their insurance coverage on their own.

Those latter claims don’t hold up well under scrutiny. Floridians miss out on the majority Medicaid According to the, expansion is possible in families that have at least one worker. Center on Budget and Policy Priorities. Und wenn die Uninsured are MedicaidA large study found that patients have greater access to health care and better financial security. still-growing A pile research.

They also appear to have better health. improveHowever, the evidence about how it works is unclear. Medicaid The impact of expansion on mortality is particularly evident. subject of some debate.

Politics of Medicaid It may be different in other countries

Today’s advocates are focused on expanding. Medicaid By using a Initiative on the ballot, which is the way it’s happened in Idaho, Missouri and several other states where Republican lawmakers had blocked it.

But Florida Republicans are already working to make that process more difficult because it’s a way for voters to circumvent GOP opposition to popular causes. And it’s not like waging a ballot campaign is easy now. The organizers recently spoke out to the Tampa Bay Times They could get married in 2026, which is when they can realistically start to have children. Medicaid Take the following measures ballot.

For more information, see DeSantisHis record in health care might be a point of comparison for a 2024 White House campaign.. Obamacare was referred to by President Joe Biden. “big fucking deal” and just signed into law reforms that make the program’s financial assistance more generous. A similar arrangement would be possible for any replacement candidate on the Democratic ticket. record There are currently 0 votes Congress Or state actions Support coverage expansions.

There’s no way to be sure how an issue will play out in the next election ― or whether it will even matter at all. But it’s not hard to imagine the contrast on health care working to the Democrats’ advantage. It is quite popular to support the Affordable Care act. these days, And Medicaid Even among the most conservative of groups, expansion polls well. Republican voters.

It may be a reason why. DeSantis And his spokespersons have very little to offer on the topic. But that silence doesn’t change the real-world impact of his posture ― or what it reveals about his priorities.