Florida’s Republican governor, Rick Scott, has announced that his will become the eighth GOP-governed state to accept the Medicaid expansion written into the Affordable Care Act, rather than “having Floridians pay to fund this program in other states while denying health care to our citizens.” The expansion is often described as “voluntary,” but, as Scott’s remark suggests, no state can opt out of paying for it. The Supreme Court, sensing that Obamacare’s provision to expand Medicaid did violence to federalism, amended it to make it less coercive; but its rewritten version did not solve the problem. The “cooperative” arrangement between the states and the federal government still undermines the political accountability that federalism is supposed to serve. Federal lawmakers can take credit for treading gingerly by giving the states options while state lawmakers can say their hands are tied.
Governor Scott has nonetheless made the wrong choice: abetting a broke federal government in expanding a fraud-riddled, debt-fueled entitlement of questionable effectiveness. This decision is particularly painful given that Scott made his bones fighting Obamacare. Scott’s decision undercuts all those Republican governors who have opted not to bilk the taxpayers of other states. His claim that the expansion will be temporary, and rescinded if the feds renege on their funding promises, is hard to credit. Expanding Medicaid tends to be much easier than shrinking it, and even if the feds do not come through in full there will surely still be “free money” on the table in the future.
Luckily, whether and how money is allocated for any expansion is not up to the governor alone. Both chambers of the Florida legislature are controlled by Republicans, and state house speaker Will Weatherford in particular has expressed skepticism. Former governor Jeb Bush is reportedly opposed as well.
Governor Scott can still salvage his claim to oppose Obamacare. A good start would be joining Oklahoma’s suit against the IRS for rewriting Obamacare to reduce the ability of state governments to opt out of some of its other provisions. As written, Obamacare does not authorize the federal government to offer its full range of subsidies or impose its full range of taxes and penalties in states that refrain from setting up insurance exchanges. The IRS has decided to pretend that the law authorizes these subsidies and penalties everywhere. Florida has joined half the union in passing on such state-run exchanges. If the Oklahoma suit prevails, as it should, Floridians will be protected from much of Obamacare and the law will be much easier to dislodge.
This is, of course, a very big if. But while the odds of stopping the Obamacare behemoth continue to look bad overall, the law’s own design flaws may yet undo it. Florida Republicans still have it within their power to improve the odds.