02/06/2019
10:31 AM EST
Obamacare
supporters are mounting a campaign to get Medicaid expansion on the Florida
ballot in 2020, potentially elevating the Obamacare program as a key election
issue in the presidential swing state.
A mix of
national and local health care groups, energized by the approval of Medicaid
expansion ballot initiatives in three conservative states
in November, have been collecting signatures for weeks to support a voter
referendum that could cover an additional 700,000 low-income Florida adults.
For now, however, the groups aren't saying much publicly about the effort.
Adding Florida
to the ranks of Medicaid expansion states is seen as a huge prize for Obamacare
supporters. Only Texas, which doesn’t allow citizen-initiated ballot measures,
has a larger population that would gain coverage by joining the optional
coverage program.
Still, the
effort faces obstacles in Florida that other successful Medicaid expansion
ballot measures didn’t. A campaign in the populous state could easily cost tens
of millions of dollars, dwarfing what the law’s supporters spent to help pass
similar initiatives in Idaho, Maine, Nebraska and Utah. And while those states
only needed a simple majority for approval, Florida ballot measures must get at
least 60 percent support.
“What our
approach has been on these ballot initiatives is you don’t actually take it to
the ballot unless you feel you’re going to win,” said Patrick Willard of
consumer advocacy group Families USA, one of the groups involved in the effort.
“That doesn’t mean that you don’t start the process — especially in a state as
complicated as Florida — and try to meet the signature goals on the front end
just to get the things off the ground.”
Obamacare
supporters were cleared by the Florida Division of Elections to begin
collecting signatures in December. Since then, they have been holding events
around the state, trying to net 100,000 signatures by the end of this month to
improve the odds of getting on the ballot.
“Medicaid
expansion is very long overdue in Florida,” said Florida Voices for Health
Program Director Louisa McQueeney, who said the ballot effort is “just in the
preliminary stages” and declined to elaborate further.
Other groups involved
include SEIU, Planned Parenthood, Organize Florida and Indivisible, among
others, according to people involved in the campaign. Many of the groups did
not provide more details or did not respond to inquiries.
Medicaid
expansion appears to be popular among Florida voters, as it is in some other
conservative states that haven't joined the program. About 60 percent of voters
support expansion, according to an October poll from the
Kaiser Family Foundation. However, the issue remains highly controversial among
Republican leaders in Florida, and it could antagonize conservatives in a state
that will be crucial to President Donald Trump's reelection effort.
The
Republican-led Florida House of Representatives has long opposed Medicaid
expansion. Former Republican Gov. Rick Scott briefly endorsed Medicaid
expansion in 2013 before opposing it. New Gov. Ron DeSantis, also a Republican,
campaigned on opposing Medicaid expansion, and he is likely to embrace the
Trump administration’s encouragement to curtail the traditional Medicaid
program.
Although ballot
measures in other states have been successful, the strategy hasn’t been without
its setbacks. In Maine, where voters approved the first expansion ballot
measure in 2017, former Republican Gov. Paul LePage refused for over a year to
implement the program. The coverage expansion only took effect last month after
his Democratic successor, Janet Mills, was sworn in.
GOP legislators
in Utah are also moving to pare back the coverage expansion voters approved in
November, citing new estimates that the program will cost the state more than
expected.
Medicaid ballot
measures in Utah and other states were bankrolled by the Fairness Project, a
Washington, D.C.-based group founded by SEIU-United Healthcare Workers West to
boost progressive causes around the country. The group spent roughly $6 million
on expansion campaigns in three states last year, according to a spokesperson.
The Fairness
Project hasn’t decided whether it will support a ballot effort in Florida, but
it continues to evaluate potential 2020 targets and talk with local advocates.
Other than Florida, the group has said it’s eyeing possible ballot measures in
Mississippi, Missouri, Oklahoma, South Dakota and Wyoming.
Representatives
from the Fairness Project are also participating in a closed-door 2020 ballot
initiative briefing in Washington, D.C. on Wednesday with America’s Health
Insurance Plans, the health insurance industry’s main lobbying organization.
“We’ll take a
look at successful expansion efforts, examine effective campaign strategies,
and explore future 2020 activities,” according to the AHIP invitation obtained
by POLITICO. The trade group did not respond to questions about whether it is
formally working with the advocacy group or if it is funding measures for the
2020 cycle.
"AHIP’s
members include many of the nation’s leading Medicaid managed care
organizations, and this is an internal briefing to which they are
invited," said spokesperson Kristine Grow.
To get Medicaid
expansion on the Florida ballot, supporters must have 800,000 valid signatures
from 14 of the state's 27 congressional districts certified by February 2020.
John Morgan, an
Orlando lawyer who spent millions on a 2016 ballot campaign to legalize
medical marijuana in Florida and is supporting a 2020 ballot measure to
increase the minimum wage, said a successful Medicaid expansion campaign
wouldn’t come cheap. Morgan estimated that an ad campaign supporting the
minimum wage increase will cost at least $10 million, on top of the millions
needed just to get on the ballot.
“I think you
might need more on Medicaid expansion,” said Morgan, who’s not involved in the
Medicaid effort.
One Florida GOP
operative believes that Republican lawmakers could mount their own ballot
effort to counter the Medicaid expansion measure.
“I’m sure
there’ll be a lot of political push for them to do that,” said the operative,
who requested anonymity to discuss political strategy.
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