The Miami Herald's coverage of the Florida Medicaid debate was significantly more comprehensive than the other four top circulating Florida newspapers, including multiple mentions of the benefits of expansion and the negative impacts the lack of expansion would have on the state and Floridians. However, similar to other top Florida papers, the Herald also largely missed out on discussing the coverage gap, which if not closed could leave hundreds of thousands of Floridians without affordable health coverage.

The Medicaid expansion in Florida, which is part of the Affordable Care Act, would extend the low income health care program to 763,890 people and create an estimated 70,000 new jobs, but the state's failure to expand Medicaid will have major negative economic and health related impacts on the state.

According to a Media Matters analysis of Medicaid expansion mentions from January 1, 2014 through March 4, 2014, the Herald discussed key benefits of expansion or the negative effects associated with not expanding Medicaid 11 times, including 5 mentions of the impact lack of expansion would have on Florida health systems. The next closest paper, the Tampa Bay Times, only had 4 mentions of the benefits of expanding or the negative effects of the failure to expand (click to expand):

This updated analysis mimics the findings of a previous Media Matters analysis of the top four highest circulating papers' coverage of Medicaid issues.

While no single article in the Herald covers all of the topics, the paper offers the most comprehensive analysis of the pros and cons of Medicaid expansion. The paper's focus on these key issues is important as Miami-Dade County has one of the highest uninsured rates in the country at nearly 40 percent of the population.

A January 3 article from The Herald's provides a clear example of what the paper did correctly in reporting the Medicaid debate. Instead of publishing a “he said/she said” back and forth between Florida's politicians or just mentioning the expansion with little context, the article discussed the cost sharing ratio of Medicaid expansion and also provided informative quotes that detailed a baseline number of potential eligible enrollees under expansion:

Though the federal government has promised to pay 100 percent of the cost [of the Medicaid expansion] for the first three years and 90 percent thereafter -- about $50 billion over 10 years -- Florida has not expanded Medicaid eligibility to include those persons and families earning up to 133 percent of the federal poverty level, which was about $15,300 a year for an individual and $31,300 a year for a family of four in 2013.

[Democratic] Rep. [Lori] Berman vowed that her party would make Medicaid expansion a Florida legislative priority in 2014.

She said the effort will include reminders to voters of the stakes involved and the House's Republican leaders responsible for refusing to hear a Senate plan that would have expanded Medicaid eligibility in 2013.

“We need to make sure the people of Florida understand,'' she said, ”you've got somewhere in the neighborhood of 840,000 to 1 million people who would be covered'' if Medicaid eligibility were expanded.

Also present in the Herald's reporting is information and analysis on Medicaid expansion's impact on doctors and health systems in the state, which could see funding cuts due to the Florida's reluctance to expand the program.

The paper's willingness to include information beyond a mere mention of expansion puts the Herald ahead of Florida's other papers. However, all the Florida papers analyzed by Media Matters shared one similar flaw: the lack of comprehensive reporting on the "coverage gap".

The coverage gap refers to a vulnerable group who do not make enough money to qualify for the Affordable Care Act's exchange tax credits, yet make too much to meet current Medicaid eligibility requirements, leaving them without access to affordable health care. While the Miami Herald did lead the pack in discussing the coverage gap, they only mentioned the gap three times in fifteen articles. The other top Florida papers studied -- the Tampa Bay Times, Orlando Sentinel, South Florida Sun-Sentinel, and Tampa Tribune -- all mentioned the gap fewer times, with the Tampa Tribune never mentioning the crisis at all.

The coverage gap is a direct effect of a 2012 Supreme Court decision and individual states' reluctance to expand the Medicaid program. As written, the Affordable Care Act (ACA) would have covered the coverage gap population as it assumed all states would expand Medicaid for those making up to 138% of the federal poverty level -- the level at which subsidies would kick in for individuals purchasing private insurance on the health care exchanges. Given an out by the 2012 Supreme Court decision, which allowed states to choose whether or not to expand, Florida and several other states have resisted expansion so far, leaving millions without affordable coverage.

Florida's uninsured population which currently falls into the coverage gap is estimated to be around 764,000 of the nonelderly, making Florida home to the second largest coverage gap in the country behind Texas. The gap in Florida also highlights the disproportionate impact rejecting expansion will have on minorities. As the Kaiser Family Foundation explained, Florida has one of the highest populations of uninsured Black and Hispanic adults in the coverage gap (emphasis added):

Large shares of adults who fall into the coverage gap reside in a small number of states, although the distribution of people in the gap across states varies by racial and ethnic group. Poor adults in the coverage gap are concentrated in several states, including Texas, Florida, and Georgia (Table 1). However, this distribution varies by racial and ethnic group. For example, over one-third (34%) of the 2.2 million uninsured White adults in the coverage gap reside in Florida (14%), Texas (12%), and Pennsylvania (8%), while over four in ten (43%) of the 1.3 million uninsured Black adults in the coverage gap reside in Florida (16%), Georgia (15%) and Texas (12%) (Figure 7). For Hispanics, the significant majority (82%) of the 1 million uninsured adults in the coverage gap reside in just three states, with nearly six in ten (59%) in Texas alone, 20% in Florida, and 3% residing in Pennsylvania.

The coverage gap crisis is exacerbated by the negative impact it will have on Florida's hospitals and health systems, especially in big cities. As The Atlantic's Emily Badger reported, prior to the ACA, hospitals, such as Disproportionate Share Hospitals, would receive federal funds to help cover the cost of providing service to low-income and uninsured patients. The federal funding of these hospitals was cut as the government expected the lost revenue to be made up by the lower cost of providing coverage for what they assumed would be an insured population. In Florida, this funding cut will now instead be amplified by state laws that require localities to provide a safety net once supported partially by Disproportionate Share Hospital funding. Badger further explained:

One last rub: Many states that have turned down Medicaid help to local communities and hospitals have long placed requirements on counties to provide the very safety net that states are now actively restraining. Eight non-expansion states have requirements that counties contribute to the non-federal share of Medicaid costs (Florida, Kansas, Nebraska, New Hampshire, Pennsylvania, South Carolina, Utah and Wisconsin).

And 15 of them, [including Florida], have a requirement that counties provide some kind of indigent care. Local government, long the caretaker of safety nets, essentially gets the responsibility without the resources - or even without a say in whether to accept them.

Rejecting expansion will touch every Floridian, whether they fall into the coverage cap or not. According to a study by the Rand Corporation, for those already with coverage, premium prices could rise because “the population of individuals who opt to enroll in the exchanges if Medicaid becomes unavailable tends to be slightly less healthy than the full population of individuals eligible for subsidies.”

Methodology:

Media Matters searched Nexis for news articles on the Medicaid expansion from the top English language papers in Florida: The Orlando Sentinel, The Sun-Sentinel, The Tampa Bay Times, The Tampa Tribune, and The Miami Herald. The search covered January 1, the first day eligible recipients could have received coverage if Florida had expanded Medicaid, through March 4, 2014, the day after the start of Florida's legislative session. The terms “Medicaid AND Expan!” were used to find any mention of Medicaid. Mentions of demographics of the newly eligible, projected enrollment numbers, costs to the state, impact on health systems, negative effects of rejection, state budget impact, and the coverage gap were tallied in their own categories.