Governor Rick Scott expressed his support this afternoon for expansion of Florida’s Medicaid program, describing the decision as a choice between “having Floridians pay to fund this program in other states while denying health care to our citizens — or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health-care reforms.”
The decision is a major reversal for Scott, whose 2010 electoral victory derived largely from his fight against the Obama health law. It apparently came after furious lobbying by Florida conservatives and Scott allies to keep him from breaking ranks.
The Department of Health and Human Services had announced earlier today that it would grant Scott’s request for a waiver, granting him more flexibility in spending Medicaid money provided by the federal government. Florida currently has an innovative premium-support system where private insurers bid for Medicaid patients and the government dollars attached to them, which would have otherwise been incompatible with the expansion.
But Scott’s low approval ratings were almost certainly the primary factor in his Medicaid expansion decision, says Michael Cannon, director of health policy studies at the Cato Institute. (Cannon served on Scott’s transition team in December 2010.) Scott’s approval rating is a mere 33 percent, and he is perhaps “vulnerable to a potential primary challenge,” according to a poll conducted last month by the Public Policy Center.
Already, Scott’s Medicaid expansion announcement is meeting with disapproval among some of his former supporters.
“The only reason to do this is that [Scott] cares more about his reelection than stopping Obamacare,” Cannon says. “It really calls into question his whole commitment to fighting Obamacare. At this point, the only thing that could restore his credibility here would be if he filed a lawsuit like Oklahoma’s to block the Obama administration’s illegal taxes. . . . . But he’s not going to win himself any allies, and he’s only going to alienate his friends, so one wonders what he’s thinking.”
Slade O’Brien, the Florida director of Americans for Prosperity, agreed: “I’m flabbergasted. I’m just blown away by this. And I think quite frankly the conservative base that supported him is going to be just as flabbergasted and disappointed. . . . Rick Scott was one of the leaders in fighting Obamcare, in fighting the expansion, and for him to cave on this sends an awful, awful signal.”
Speaking at a news conference Wednesday afternoon, Scott said that while Florida will not commit to running a state exchange, “we will support a three-year expansion of our Medicaid program under the new health-care law, as long as the federal government meets their commitment to pay 100 percent of the cost during this time.”
If Florida’s legislature follows Scott’s direction, at least a million Floridians would enroll in Medicaid, including some who already have health care. The federal government would contribute more than $26 billion over the next ten years to cover these new Florida dependents.
Michael Tanner, a senior fellow at the Cato Institute, says he’s skeptical Florida will receive its promised money.
“Trusting in federal promises to give you money in the future is pure fools gold,” he tells me. “If Governor Scott hasn’t noticed, we’ve got a budget problem in Washington, and I’d expect Medicaid to be on the table when it comes time to cut. In fact, we already know that the Obama administration put a cut in Medicaid on the table briefly during cliff negotiations.”
Scott’s statement appeared to acknowledge this possibility.
“Legislation we would support would sunset after three years and [would] need to be reauthorized,” the governor said. “It would also sunset if the federal government backed away from their 100 percent commitment during this period.” However, Scott added, “I want to be clear that we will not simply deny new Medicaid recipients health insurance three years from now.”
Scott may face resistance in the Florida House. “The Florida Legislature will make the ultimate decision,” said Speaker Will Weatherford in a news release responding to Scott’s decision. “I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability,” Weatherford stated.