TALLAHASSEE, Fla. -- It's been two years since the onset of Medicaid expansion, and a new report says it's paying off for states that have helped close their "coverage gaps" with economic benefits for health-care systems and the people they serve. But Florida is missing out.

More than a half-million Floridians can't afford marketplace health insurance but don't qualify for Medicaid. The research pointed to a ripple effect on the stability of the state's health-care delivery system.

Florida House Minority Leader Mark Pafford, D-West Palm Beach, chief executive of Florida Community Health Action Information Network (CHAIN), blamed the Legislature's failure to act for Florida hospitals having to cut staff and reduce services.

"I'm talking about the providers dealing with people who need health insurance, who are in poverty many times, who are working full-time jobs," he said, "and so that economic impact to those hospitals is really unjust."

According to the report from the Georgetown University Center for Children and Families, hospitals and clinics in Medicaid expansion states report opening new facilities, buying new equipment and hiring staff. To date, 31 states and the District of Columbia have chosen to expand Medicaid. Report co-author Jack Hoadley, a research professor at the Georgetown center, said states that have expanded Medicaid have seen major reductions in the amount of uncompensated care delivered by safety-net institutions, signifcant drops in the number of uninsured residents and budget savings for hospitals and community health centers.

"This is the kind of ripple effect," Hoadley said. "It's not just the patient now comes in and gets a service, or now comes in and is able to pay for the service as opposed to receiving charity care, but the dollars that are saved -- or the dollars that are brought in to these institutions -- really are used in ways that really fundamentally change the way care is delivered."

Pafford said he finds it ironic that Gov. Rick Scott has taken such a strong stand against Medicaid expansion but is asking the federal government for more money to help prevent and monitor the spread of the Zika virus in Florida.

"So, at a time where the state's ability to respond should be at its greatest," Pafford said, "he turned his back on Medicaid expansion, which was the delivery of those dollars to react to Zika."

Opponents of expanding Medicaid often claim it will place a higher financial burden on state budgets, but the report found fiscal benefits for many expansion states -- from $25 million in savings in Kentucky to $100 million in Washington state.

The report is online at ccf.georgetown.edu.


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A new report analyzes Pennsylvania's existing voucher programs, that divert public funds to private schools.

This comes on the heels of Gov. Josh Shapiro's plan to create a new voucher program for K-12 students.

Diana Polson - senior policy analyst with the Keystone Research Center - said last year's Commonwealth Court decision ruled that Pennsylvania's system of funding public education is unconstitutional, therefore the state doesn't have a dollar to waste on expanding existing private-school voucher programs or creating a new one.

"The basic-education funding commission estimated the state must pay $5.1 billion over the next seven years to make sure our public schools are funded equitably and adequately," said Polson. "Meanwhile, our report finds that existing private-school voucher programs are siphoning millions from taxpayers with little to show for it."

Supporters argue that vouchers let children leave under-performing public schools and get a better education at private schools.

Polson said Pennsylvania's voucher programs have no "meaningful educational or financial accountability," so they really have no way of knowing if these programs operate as intended or are beneficial to low-income or moderate-income students.

Polson said the report reveals that the programs have grown, and just this year they will cost the state nearly $500 million.

However, these voucher programs exclude students in rural areas, because there are few if any participating private schools in these regions.

Local public schools remain the primary option for most rural families.

"We also found that private schools receiving these funds are allowed to - and do - routinely discriminate against students for reasons including disabilities, sexual orientation, religious beliefs and more," said Polson. "These programs are also exclusive. They subsidize the state's most elite and expensive private schools as well as affluent families."

Polson said the report reveals that the Independent Fiscal Office estimated that the average EITC program scholarship was $2,314, while the Opportunity Scholarship Tax Credit was slightly less at around $2,000.

The cost of attending one of the top 25 private schools in Pennsylvania is around $41,000 per year. This means these schools are still out of reach for many low- and moderate-income families.

As Nebraska's 2024 legislative session draws to a close, family caregivers and their supporters are closely watching the progress of Legislative Bill 937, the Caregiver Tax Credit Act.

The bill provides eligible family caregivers up to $2,000 in tax credits for out-of-pocket expenses or up to $3,000 if the family member receiving care has dementia or is a veteran.

Jina Ragland, state director of advocacy and outreach for AARP Nebraska, said family caregivers are filling health care gaps in the state, especially with 15 Nebraska counties currently lacking a nursing home or assisted-living facility. Ragland argued the state's family caregivers need and deserve financial support.

"We really feel they're the backbone of the U.S. care system," Ragland emphasized. "Especially here in Nebraska because they're helping parents, they're helping loved ones live independently in their homes."

Family caregivers in the U.S. spend an average of $7,000 per year in out-of-pocket expenses. Employed caregivers sometimes lose wages when they have to take time off for caregiving responsibilities. Others retire early, losing both wages and retirement income.

The bill includes an income limit of $50,000 for individuals and $100,000 for married couples. Sen. Eliot Bostar, D-Lincoln, introduced the bill on behalf of AARP Nebraska. The legislature is expected to debate the measure for the second time this week.

Joyce Beck of Grand Island knows firsthand the emotional and financial strain of being a caregiver and losing a loved one. She retired early to care for her husband, who suffered from multiple sclerosis and cancer. In addition to significant out-of-pocket expenses, her Social Security and pension payments are both lower because she retired early.

Beck said she knows some Nebraskans face bigger financial struggles as a result of their caregiving.

"If there's any financial support that we can give, that would be so beneficial," Beck contended. "Some people don't have the option of a retirement account or a pension plan, so $2,000 would be huge for them. "

Ragland stressed family caregivers are helping Nebraska taxpayers as well. When their caregiving delays or prevents expensive-nursing home placement, it contributes to lowering the state's Medicaid costs.

"An important concept for people to understand is the value of those people who are just doing what they think is right," Ragland asserted. "The time and the money and the energy that they're providing as family caregivers to offset, again, the gaps in the care services that we have in our communities."

Six states currently offer a caregiver tax credit, and there is a bipartisan bill in the U.S. Congress to enact one at the federal level.

As California faces a $38 billion budget deficit, state lawmakers have identified $17 billion in potential cuts before the Legislature begins crunching the numbers later this week.

Initial plans include shifting some funds away from job training programs but the idea is getting some pushback. Advocates of the programs said at a time when skilled worker shortages plague essential sectors, investments in job training are needed.

Lisa Countryman-Quiroz, CEO of San Francisco-based Jewish Vocational Service, a nonprofit job training agency helping to match jobseekers with employers, said current economic conditions call for investment in programs like theirs.

"This is absolutely critical given the cost of living, given rising economic inequality in the state of California, the people who really want to be able to provide for their families, people who want to be able to advance in their careers," Countryman-Quiroz outlined. "We are helping people get there."

Democrats, who hold a supermajority, agreed last week to reduce the state's projected shortfall through spending cuts, delays, deferrals and cost-shifting. The budget debate could start as soon as Thursday.

Countryman-Quiroz said while job training can have high costs, workforce investments often pay for themselves by closing opportunity gaps in employment and creating economic revenue. She cited one program, known as the High Road Training Partnership.

"We see a really positive return on investment," Countryman-Quiroz pointed out. "Every dollar that JVS specifically has received in HRTP funds has resulted in $2 in wages for the jobseekers that we work with."

Jordan Hernandez, a graduate of the High Road Training Partnership, said he has successfully accessed both education and job opportunities.

"This program has given me a lot of confidence, especially with school things," Hernandez noted. "I never thought I'd be in school, so once I got into this program, I was very nervous, but they were very welcoming. They treated me with respect, and they understood where I was coming from."


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