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Amy Sherman
By Amy Sherman July 9, 2014

By not expanding Medicaid, Florida is missing out on 63,800 jobs, Charlie Crist says

The White House has new ammunition for those fighting for Medicaid expansion: It would create jobs.

The study by the White House Council of Economic Advisers — titled "Missed Opportunities" — provides a state-by-state analysis of how many jobs would be created by expanding Medicaid. The number for Florida: 63,800 jobs between 2014 and 2017.

The study is part of the Obama administration’s promotion of the Affordable Care Act, which includes the federal government picking up the initial tab for Medicaid expansion.

Democrats including former Gov. Charlie Crist are using the study to attack Scott for Florida’s decision not to expand Medicaid. Crist is expected to win his primary and face Scott in November.

"Expanding Medicaid would create 63k jobs -- but Rick Scott still won’t do it," Crist said on Twitter July 2.

Florida’s Republican-led Legislature opposes expanding Medicaid. Scott once opposed it, too, but switched positions in 2013 and now supports it. Supporters of the expansion say Scott hasn’t done enough to turn the Legislature around.

Here, though, we wanted to focus on jobs. Would expanding Medicaid create 63,000 jobs?

White House study

Medicaid is a joint state and federal program aimed at providing health insurance to the very poor. The 2010 Affordable Care Act encourages states to expand eligibility and agreed to pay 100 percent of the expansion for the first three years, declining to 90 percent in 2020 and beyond. The expansion would have covered an additional 848,000 Floridians.

Studies predicting job growth are based on the idea that as states expand Medicaid, new patients will access medical services they haven’t in the past. Extra revenue will allow health care facilities to hire new workers.

The new study relies on previous studies, including one about the Oregon Health Insurance Experiment, in which some residents got Medicaid through a lottery. Research showed people in Medicaid got preventative tests such as mammograms, cholesterol screening and pap smears compared to the control group. The White House predicts that Medicaid expansion would allow tens of thousands of Floridians to get those preventative tests.

If Florida expanded Medicaid, it would get $15 billion from the federal government between 2014 and 2016. That would lead to 63,800 cumulative "job years" between 2014-17. It defines a "job year" as one person employed for one year.

The study focuses on short-term job growth -- not what would happen to jobs over the long-term. The report briefly touches on the possibility that access to Medicaid could cause some people to work less or not at all -- while healthier, less financially stressed people might work more. It cites one study that found Medicaid enrollment had a statistically insignificant impact on labor supply, while other research found reductions in labor supply.

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Other studies on expanding Medicaid in Florida have arrived at different numbers. The Florida Hospital Association’s most recent analysis in 2013 predicts 120,000 jobs each year over about a decade -- the association supports expansion. Moody’s, a financial analysis firm that doesn’t have a position on the health care law, last year predicted Medicaid expansion would create 10,000 to 30,000 jobs in Florida.

Kaiser Family Foundation summarized 32 studies Medicaid expansion in various states including Florida and predicted that it will have a positive effect on jobs over the next decade.

Experts offer caveats or criticisms of report

Many experts we interviewed generally agreed that the federal government pumping more money into the state to expand Medicaid would lead to new jobs, though they cautioned it’s difficult to pinpoint a number.

"It is next to impossible to know exactly how many jobs (or which jobs) are created by a policy like this, given the many other changes in the landscape," said Harvard professor of health economics Katherine Baicker.

While the federal government picks up the initial expansion costs, in later years the states will have to contribute.

That will "wreak havoc" on long-term state budgets because state spending on Medicaid is forecasted to outpace state tax revenues, said Dan White, who authored the Moody’s report. Ultimately it’s a judgment call by elected officials if the cost of expansion 10 years down the line is worth the number of jobs it will provide, he said.

Michael Tanner, a health care expert at the libertarian Cato Institute, says the report ignores one side of the equation. "What about tax money Floridians have to pay into the system because we are spending more money on Medicaid? What about jobs lost because of that?"

We asked Scott’s campaign for his opinion about the jobs’ report and got back a statement that didn’t address our question.

Our ruling

Crist said, "Expanding Medicaid would create 63k jobs."

A study released by the White House said federal dollars that Florida would have gotten to expand Medicaid would create 63,800 jobs between 2014 and 2017.

Most of the health care experts we interviewed agreed that injecting billions of federal dollars into Florida for Medicaid would spark some job growth, but it’s difficult to pinpoint a number, particularly as there are other changes in the health care landscape. Other studies have found numbers as high as 120,000 and as low as 10,000.

We rate this claim Half True.

Our Sources

White House Council of Economic Advisers, "Missed Opportunities: the consequences of state decisions not to expand Medicaid," July 2014

Former Gov. Charlie Crist, Tweet about Medicaid and jobs, July 2, 2014

Tampa Bay Times, "Study links Medicaid, jobs," July 3, 2014

PolitiFact, "Will Medicaid expansion create jobs? A review of the evidence," Feb. 2013

Study by the University of Florida economist Alan Hodges commissioned by the Florida Hospital Association, "Economic impacts of extending health insurance coverage in Florida," March 28, 2013

National Bureau of Economic Research, "Public health insurance, labor supply, and employment lock," July 2013

Florida Gov. Rick Scott, "We must protected the uninsured and Florida taxpayers with limited Medicaid expansion,"Feb. 20, 2013

PolitiFact, "Rick Scott calls health care law a ‘job killer,"April 2, 2012

Miami Herald Naked Politics blog, "In defense of Rick Scott,"Feb. 22, 2013

Health News Florida, "Medicaid expansion can backfire: Witnesses,"Feb. 12, 2013

Families USA, "Florida’s Economy will benefit from expanding Medicaid,"February 2013

Alan W. Hodges and Mohammad Rahmani, University of Florida, report for the Florida Hospital Association, "Economic impacts of the Patient Protection and Affordable Care Act,"Nov. 26, 2012

Florida Center for Fiscal and Economic Policy,"Unhealthy choices: Flawed Medicaid proposals would kill Florida jobs,"January 2011

Henry J. Kaiser Family Foundation, "The role of Medicaid in state economies: A look at the research,"January 2009

Henry J. Kaiser Family Foundation, "The role of Medicaid in state economies and the ACA," November 2013

Florida Senate Select Committee on Patient Protection and Affordable Care Act, Meeting packet includes testimony about Medicaid expansion in other states, Feb. 11, 2013

Florida House, Select committee on Patient Protection and Affordable Care Act, Feb. 18, 2013

Georgetown Health Policy Institute, Assessing Florida’s Medicaid Reform, November 2012

New York Times Economix blog, Medicaid Expansion and jobs, July 3, 2012

Moody’s Analytics, "Opting out: The effects of Medicaid expansion on state budgets and the economy," January 2013

Billy Hamilton Consulting for Texas Impact and Methodist Healthcare Ministries of South Texas,"Expanding Medicaid in Texas: Smart, affordable and fair,"January 2013

New England Journal of Medicine, "The health care jobs fallacy,"June 28, 2012

Forbes, "Will Medicaid expansion create jobs?"Feb. 25, 2013

Miami Herald, "Fla. governor supports Medicaid expansion,"Feb. 21, 2013

Tampa Bay Times, "Can Florida afford to say no to Medicaid expansion?"July 20, 2012

NPR,"Will Medicaid bring the uninsured out of the woodwork?"July 11, 2012

Interview, Dan White, Moody’s senior economist, July 7, 2014

Interview, Linda Quick, president of the South Florida Hospital and Healthcare Association, July 3, 2014

Interview, Alan Hodges, University of Florida economist, July 3, 2014

Interview, Casey B Mulligan, University of Chicago economist, July 8, 2014

Interview, Monica Corbett, spokeswoman Florida Hospital Association, July 6, 2014

Interview, Bruce Rueben, president of the Florida Hospital Association, July 6, 2014

Interview, Michael Tanner, senior fellow at Cato, July 7, 2014

Interview, Jessica Santillo, White House spokeswoman, July 3, 2014

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By not expanding Medicaid, Florida is missing out on 63,800 jobs, Charlie Crist says

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