The build-up begins to get Medicaid expansion on the ballot in FL

Angela Dumala speaking at a press conference in Tampa on March 27, 2024. (Photo by Mitch Perry/Florida Phoenix)

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Andrea Dumala’s Honda Accord was idling at a red light on a Pasco County road in 2014 when it was violently rear-ended by a Ford Explorer moving at 50 miles per hour. The driver was later revealed to have been under the influence.

The accident changed her life. Although Dumala was later diagnosed with injuries to her spinal cord and a “TBI’ — traumatic brain injury — that didn’t happen until a few years after the accident, which is why she initially was denied disability medical coverage. Working with an attorney in 2020, she finally won that coverage, which allowed her to get on Medicaid and take a financial break from her medical costs.

Medicaid provides medical coverage to low-income individuals and families whose costs are shared between the state and federal government.

When Dumala reapplied for her Medicaid benefits a year ago , however, she received a shock.

“Our records indicate that you no longer receive Medicaid,” began the document sent to her by her health care provider dated Aug. 14, 2023, with the information that she had a six-month grace period to re-qualify.

“They stated to me, ‘Oh you’re not eligible because you have an asset,’ and they were seeing that asset from my savings as not making me Medicaid-eligible anymore. And it was something that I just couldn’t wrap my mind around, like, how can that be possible?” Dumala recalled in a Zoom conversation with the Phoenix.

“Especially for someone who doesn’t work. I don’t have the luxury of working overtime or a second job or I rely on that help, and to have that taken away is excruciating and it’s very scary when you don’t understand, and you don’t know what to do.”

The loss of Medicaid coverage meant Dumala couldn’t pay for her prescription drugs, such as Olumiant, which she uses to treat alopecia areata (a disease that causes hair loss) and without insurance can cost several thousand dollars for a 30-day supply.

“I was losing my hair in chunks a few years ago, and I came down with an autoimmune disease, and that medicine helped me so much for a few years, and I could not wrap my mind around not having that. It was incredibly scary, and fortunately I was able to work something out with my doctor and she fought hard for me where I could still receive the medication with a co-pay,” Dumala said.

“But to me, why? Even with a copay when it was being taken care of, and then just having the stress of it, how stress affects your body. Like there’s enough to worry about, like, it should never have occurred in the first place.”

Dumala, 40, is one of more than 653,000 Floridians who lost their Medicaid coverage over the past year because the state determined they were ineligible, according to KFF .  Enrollment had increased during the public health emergency ignited by the coronavirus pandemic in 2020, when the federal government paid states to keep residents enrolled, regardless of their situation. That changed at the start of April 2023.

Dumala’s also one of an estimated nearly 315,000 Floridians in the so-called coverage gap, ineligible for Medicaid or insurance through the Affordable Care Act, according to the Center on Budget and Policy Priorities ( KFF places that number at 570,000).

She’s now working as an advocate with Florida Voices for Health , a nonprofit advocacy group that works on multiple health issues including expanding Medicaid. The organization hosted a news conference touting its new push to get Florida to join the majority of states that have expanded Medicaid.

The press conference was staged in March on Bayshore Boulevard in South Tampa, with Tampa General Hospital in the background.

Quiet organizing

“We all know the situation that Florida is in when it comes to access to care,” said Scott Darius, executive director of Florida Voices for Health, during the press conference.

“There are just folks in this state who don’t have access to the care that they need. And, unfortunately, we have over half a million Floridians who don’t have access to care whatsoever. Who don’t have access to Medicaid because of how restrictive our program is, and don’t have access to the ACA tax credits because they don’t make enough to get there.”

Florida Decides Healthcare is the new political entity created to get Medicaid expansion on the 2026 ballot.

With high-profile campaigns pushing for the state constitutional amendments legalizing adult cannabis use and restoring a woman’s right to an abortion up until the point of viability, the push to collect the close to 1 million signatures to qualify to place Medicaid on the ballot in two years has been doing its work without much fanfare. But organizers say they are making progress.

“ We have already established a network of petition collection hubs throughout the state, with 20 in operation so far, and efforts to increase that number are ongoing,” said Jake Flaherty, campaign manager for the organization, in an email. “We have collected thousands of petitions from volunteers thus far and are preparing to dramatically expand our efforts between the end of this election cycle and the beginning of next year.”

Since a 2012 U.S. Supreme Court ruling made the Affordable Care Act’s Medicaid expansional optional, the issue initially emerged as largely partisan, with Republicans against. Opposition has withered in some conservative-led “red” states over the years. Not in Florida, though, one of 10 states that have not expanded Medicaid (seven of which are in the South).

Dumala became an activist in the cause after her father heard Tampa health-care advocate Karen Clay discussing the campaign during a radio interview and thought she could be an ideal representative to speak publicly about the need for Florida to get behind the movement.

“It was one of the best things to happen, because they gave me the opportunity to not only speak about my journey, but I’m hoping to advocate for others as well, because you’re in such a vulnerable position and I don’t feel people know what to do. They really don’t. And feeling that way and being vulnerable to the system, it just breaks my heart that other people are enduring that, and I want to do whatever I can to help.”

If the measure gets the sufficient number of signatures to qualify for the 2026 ballot, it will likely face fierce opposition.

Opposition

The Paragon Health Institute, led by former Trump administration economic adviser Brian Blase, has published a paper contending that Medicaid expansion would be bad for Florida’s economy and would create harmful health effects.

“Florida has made the right decision to not expand Medicaid under the ACA thus far,” the paper concluded. “Expanding would necessitate higher state taxes, force cuts to other state priorities, and reduce access to care for traditional Medicaid enrollees and many new Medicaid enrollees, most of whom would replace private coverage with Medicaid.”

Except for a brief moment in 2013 when then-Gov. Rick Scott floated the idea, Republicans in Tallahassee have fiercely opposed the notion of expanding Medicaid, and that theme continued earlier this year when Senate President Kathleen Passidomo said as the session began that her Live Healthy legislation wouldn’t include expanding Medicaid.

“I want to be clear. I’m not going to spend the next 60 days re-litigating Medicaid expansion. I understand the arguments both for and against,” she said. “We have had the debate several times over the last decade. Medicaid expansion is not going to happen. It is not a quick fix. It is not a panacea.”

The Legislature in deep red Mississippi seriously considered Medicaid expansion earlier this year, but an insistence by members of the state Senate about requiring anyone who wanted health benefits to have to work a minimum number of hours to qualify killed the proposal, according to Mississippi Public Broadcasting .

Mississippi, like the majority of the remaining states that haven’t expanded Medicaid, doesn’t have the option of the public going around the legislature and putting a measure on the ballot by themselves. Florida does, despite the 60% vote requirement to pass constitutional amendments, one of the highest thresholds in the country.

A survey conducted by Mason-Dixon Polling & Strategy of 625 registered voters conducted in late March showed that 76% support expanding Medicaid in Florida, with just 14% opposing and 10% undecided.

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