CHIPLEY — Providing Medicaid benefits to people without improving the incentives for physicians to accept federal benefits is a “cruel joke,” said Sen. Don Gaetz on Tuesday.

CHIPLEY — Providing Medicaid benefits to people without improving the incentives for physicians to accept federal benefits is a “cruel joke,” said Sen. Don Gaetz on Tuesday.

Gaetz (R-Niceville) met with Northwest Florida Community Hospital CEO and President Pat Schlenker and a handful of doctors and hospital staff when the Senator was in Northwest Florida for a “Neighborhood Day.”

“For the federal government, Medicaid reform was all or nothing,” Gaetz said. “The governor went from saying ‘no, no, hell no,’ to ‘may I have two scoops please?’”

The Florida Legislature adjourned in May without expanding the state's Medicaid program, passing up more than $50 billion in federal funding and dealing a defeat to Gov. Rick Scott.

And with little fanfare, perhaps the most controversial issue of the session fizzled, leaving roughly 1.1 million Floridians uninsured for now. It was unclear whether Scott will call a special session or if the issue will still be unsettled when the Legislature reconvenes next March.

The Senate had passed a bill supported by Scott, but the House Republican leadership had refused to consider it, so the bill died at adjournment.

The House and the Senate had different ideas of what Medicaid reform should look like in Florida, but in the end, the state took Washington’s mandates.

Gaetz said he supported increasing physician reimbursements under Medicaid as a means to encourage more physicians to accept the benefits.

It once seemed obvious that Medicaid expansion wouldn't happen in Florida, as Scott had entered politics in 2009 running national cable TV commercials criticizing the President Barack Obama's health care plan.

Scott made a dramatic about-face when he announced his support for Medicaid expansion under Obama's Affordable Care Act, calling it the "compassionate" and "common sense" choice since the U.S. Supreme Court had upheld the law sometimes called "Obamacare." But the House and Senate voted against a straight Medicaid expansion early in the session, saying they didn't want to expand an already broken system.

Scott, the Senate, House Democrats, Florida hospitals, health advocates and a diverse mix of business and labor groups all lined up in support of a bill proposed by Republican Sen. Joe Negron that would have drawn down more than $50 billion from the federal government over the next decade and given it to an estimated 1.1 million Floridians to purchase private insurance.

The proposal would have saved the state money, but House Republicans resisted accepting any funding tied to the federal law and instead passed a bill that would use $237 million in state funds to cover about 115,000 residents. The Obama administration has sought to offer health insurance to more Americans by extending the Medicaid eligibility levels to those making up to 138 percent of the poverty level. But the House plan only addressed residents making at or below 100 percent. That's roughly $11,000 a year for a single person and about $19,500 for family of three.

Scott slammed that plan, saying it would doubly tax Florida families as they would be paying federal taxes to pay for people in other states but would get no benefit themselves.

“Just because we give you a Medicaid card, doesn’t guarantee you will have access to health care,” Gaetz said. “I learned from my experience as a hospital administrator that nothing happens in a hospital until a doctor signs an order.”

Gaetz said he met with a Washington County resident earlier in the day who said he could not get an appointment to see a physician through his Medicaid coverage.

“Until we can provide more coverage, giving out another million Medicaid cards is just a cruel joke,” the senator said.

The Patient Protection and Affordable Care Act will also bring mandates that are going to negatively impact rural hospitals, Gaetz said. “It is going to take all of your skills and abilities to maintain the level of care that you are currently providing.”

Schlenker said that under the new Medicaid reimbursements, the hospital is getting about 96 percent of the allowed payments, which means the hospital pays the remaining four percent out of its own funds.

“If your business is running at a four percent loss, then you wind up having to move that cost on to your other, insured patients,” Gaetz said. A business won’t stay in business long if it loses four cents on every dollar, he added.

The federal government will continue to put constraints on the rural hospitals, Gaetz said. “I wish I could tell you there was some magic solution, but there isn’t,” he said.

Insurance premiums are also expected to rise as the Affordable Care Act continues to be implemented. “Blue Cross of Florida predicts their rates will increase by 50 to 60 percent,” Gaetz said. Part of that increase comes from the federally mandated reduction of six categories or “bands” of coverage to three categories.

With fewer categories of age, the average premium for each band will increase.

“Since I am older, I want to thank you for subsidizing my insurance from now on,” Gaetz joked.