TALLAHASSEE — For the past two years, the Republican-dominated Florida House has turned away federal funds intended to expand health care coverage to nearly a million uninsured Floridians.

But there is a growing list of reasons why 2015 might be different.

Chief among them: increased pressure from businesses, which could soon face fines for failing to provide health care coverage to employees.

Since December, two influential business groups — Associated Industries of Florida and the Florida Chamber of Commerce — have issued policy papers urging lawmakers to accept the federal dollars to expand Medicaid. Both advocate for a Florida-specific plan that would require a waiver from the federal government.

House Speaker Steve Crisafulli, R-Merritt Island, won't say outright if he supports either proposal. But he said last week that "many of the policies they are advocating for are policies that the House has passed, or worked on over the years."

Consumer advocacy groups like Florida CHAIN are encouraged.

"There are more hospitals, businesses, and community leaders standing up and saying we can't afford to wait any longer," advocacy director Athena Smith Ford said. "We feel really good about our chances for success in 2015."

Medicaid expansion was one of the biggest battles of the 2013 legislative session. The Senate passed a plan that would have allowed Florida to accept the federal money and create a state-run private insurance exchange. But the House insisted on an alternative plan that would have created a smaller, state-funded program. The two chambers failed to reach consensus.

Neither took up the fight in 2014, an election year.

This year is different. Most state lawmakers aren't facing re-election. And other issues have been bubbling up.

Last month, a federal judge in Miami ruled that state lawmakers had been setting the Medicaid budget at an artificially low level, discouraging pediatricians from providing services to needy children and effectively reducing their access to care.

In addition, a health care consultant commissioned by the state reported on Thursday that Florida hospitals could lose about $1.3 billion in federal funds to help hospitals treat poor and uninsured patients — raising the possibility that Florida legislators would have to raise taxes or dip into general revenues to replace those dollars. Jackson Memorial Hospital in Miami-Dade County is among the biggest potential losers.

Come June 30, Florida will no longer be able to rely on a special pot of supplemental funds known as the Low Income Pool, or LIP. That program is set to end under an agreement with the Centers for Medicare and Medicaid Services, a federal regulatory agency.

Florida's health care budget will face a significant strain, said Senate Health Care Appropriations Subcommittee Chairman René García, R-Hialeah.

"If LIP goes away, that's a significant amount of money," García said. "We are going to have to figure out a way to cover that gap. The best way will be with some kind of plan that allows us to access the federal dollars."

Florida won't be the only state having the discussion.

Debra Miller, health policy director for the Council of State Governments, said all 23 states that have not expanded Medicaid are facing new pressures. She expects some to design unique programs like those that have been approved in Arkansas, Iowa, Michigan and Pennsylvania.

Both the Florida Chamber of Commerce and the Associated Industries of Florida want a Florida-specific plan. The AIF proposal calls for Florida to invest the money into a state-run private exchange. All beneficiaries would be required to pay premiums, but the premiums would go into savings accounts that could be spent on health care and education costs.

One recommendation from AIF — a requirement that all beneficiaries work or seek employment — could have trouble winning approval from the federal government. Federal health officials rejected a similar proposal from Utah.

Medicaid critics remain skeptical.

Chris Hudson, the Florida director for the conservative advocacy group Americans for Prosperity, said the plan being offered by AIF is "no different than traditional Medicaid expansion."

"It has a new title and new supporters, but it hasn't fundamentally changed," he said. "It is something we are mindful of and will be watching very closely."

Hudson has close ties to powerful House leaders. His father is state Rep. Matt Hudson, a Naples Republican who chairs the House Health Care Appropriations Subcommittee.

Contact Kathleen McGrory at kmcgrory@MiamiHerald.com. Follow @kmcgrory.