JACKI LYDEN, HOST:
Let's switch to Florida now, where opposition to the Affordable Care Act has been strong among state lawmakers. Joining us now is Florida Senate President Mike Haridopolos. Thanks for being with us.
MIKE HARIDOPOLOS: Thank you, Jacki, for the opportunity.
LYDEN: Mr. Haridopolos, your governor, Rick Scott, has challenged whether the Affordable Care Act is even law at this point. What's your stand on that?
HARIDOPOLOS: Well, I agree with the governor and I agree with our attorney general, who's leading the fight against what is now known as ObamaCare for one simple reason: We can't afford it. It's a program that already takes (unintelligible) Medicaid takes about 1/3 of our entire state budget, and with the expansion of Medicaid, we're going to see that budget number increase to well over 1/3.
JEFFREY HESS, BYLINE: So there are about three million on Medicaid?
HARIDOPOLOS: There's about three million people on Medicaid, correct.
LYDEN: And I understand that absorbs a very big portion of the state's budget, but there's also been criticism because Florida has refused federal money, about four hundred million dollars to expand Medicaid. How would you respond to the criticism that the state is sacrificing help in an ideological battle, needed help for citizens?
HARIDOPOLOS: Well, I don't consider it an ideological battle. I consider it about quality healthcare. As you mentioned, it takes 1/3 of our entire seventy billion dollar budget, and what we've also found, and I know firsthand, is that Medicaid is not an effective healthcare delivery system, because my wife's a doctor. Not only here in the States but she actually gained some of her training in England, so she knows very well about what we call a universal healthcare system.
It does not provide the high quality of care we expect here in America. About a 60/40 ratio exists, meaning for every 40 cents the state's put in, then national government puts in 60 cents. Now, that's a good deal if you can afford it, but as you know, like so many other states, we're challenged to balance our budget, and unlike in Washington, we have to balance our budget.
It's a constitutional mandate, whereas in Washington, as you know, they're allowed to have an unbalanced budget.
LYDEN: Why not expand Medicaid, though, if the federal government will pay for it?
HARIDOPOLOS: Well, it's not so much the idea that they'll pay for it. In the short run, yes, they'll pay a good share of the expansion, but a couple things will happen. One, over time that percentage of what the state will have to pay will increase, and second, as you know, Medicaid doesn't truly cover the health care cost, and so that means when the doctors, let alone the hospitals, are not being reimbursed for the true cost, there's going to be cost shift, meaning those people who have private insurance will have to make up for the shortfall that the government fails to pick up in the true cost.
LYDEN: What if the Supreme Court upholds this law? Is Florida prepared to implement it or do you think by refusing money, not setting up exchanges, you're kind of gambling that it will be defeated?
HARIDOPOLOS: Well, first of all, we are hopeful that will be defeated, but beyond that, to your point, I think it's an excellent one - what we do if this law is implemented by the Supreme Court? Well, first of all, I believe in the Constitution, you have to follow the law - we will. But we believe strongly that the state should have flexibility. After all, we're a federal government. We're not a unitary government like the government we broke away from, that being Great Britain, which is a national government center of power.
Federal government shares power to the states and the national government. This is why we're also fighting what is now known as ObamaCare, because we simply can't afford it and it also erodes our sovereignty as a state and not allow us the flexibility we need to provide quality healthcare for our citizens.
LYDEN: And you talk about your sovereignty as a state, but other things are federal programs. I'm thinking of the Veterans Administration, for example.
HARIDOPOLOS: Again, I agree with all that, but those are paid for exclusively by the federal government and we all pay taxes towards Washington. But a system like Medicaid, it's designed to be a federal/state share, meaning shared responsibility. If you put this mandate in place, over time, history has shown that the national government will push more of those costs to the states and, more importantly, we don't like kind of the one-size-fits-all solution.
In Florida, we have a very diverse state. North Florida is very different than south Florida, so if you try to have a delivery system that's a one-size-fits-all solution, those citizens are not going to get the high quality care they expect.
LYDEN: If the Supreme Court does strike down the law, what is the state's plan? You say Florida's led the way in opposition. That's true, but it also has, what, about 20 percent uninsured population?
HARIDOPOLOS: Yeah. I would imagine around 20 percent. That's correct. Though what we have tried to do more than anything else is provide affordable care. I mean, one of the reasons why I'm concerned about this law is that if you continue to put more people on Medicaid and there is that cost shift, that means that private insurance will become even more unaffordable. And so we can't afford that particular rise.
And where we'd like to go again - we're willing to step up. In our Medicaid law that we passed in 2011, we came up with a plan that Washington, if they'd simply agree to it, would allow us the flexibility where people would go to clinics as opposed to into the emergency rooms on Medicaid and it would allow for some more accountability within the system because, as most people know, if you don't have the bill that ever comes to you in the mail, you tend to over-utilize services.
So we think Medicaid needs to be more of an accountable system. That's what we created here in Florida and we're hopeful that the Obama administration will approve this. We can prove that our theory is correct, much like we did welfare reform in the late 1990s.
LYDEN: So you're saying, let the state administer it?
HARIDOPOLOS: That's all we're asking. Again, we think that we have responsibility to help people who are in a difficult financial situation, but give us the flexibility given the tremendous amount of money that's being spent.
I'm personally a college professor. I've been teaching at the college level for almost 20 years and, because we have so many Medicaid bills that are growing to now one-third of the budget, it takes away from education and transportation, the environment, let alone economic development programs.
We want to have a better cost containment and high quality care and we're afraid that Washington's one-size-fits-all solution won't fit a diverse state like Florida needs.
LYDEN: Mike Haridopolos is the president of the Florida Senate and he joined us from his home in Merritt Island, Florida. Thanks very much for being with us.
HARIDOPOLOS: Thank you, Jackie. Have a great day.
LYDEN: You too. Transcript provided by NPR, Copyright NPR.