Scott opts in to Medicaid expansion
Published: Wednesday, February 20, 2013 at 10:02 p.m.
Last Modified: Wednesday, February 20, 2013 at 10:02 p.m.
TALLAHASSEE - Even before Gov. Rick Scott ran for office, the former hospital company CEO made a name as one of the nation's leading opponents of President Barack Obama's health-care reform plan.
He spent $5 million of his own fortune backing a group called Conservatives for Patients Rights that espoused a "free-market" approach to health care rather than the expansion of government programs.
As governor, he helped lead the legal challenge to the Affordable Care Act. When the U.S. Supreme Court upheld the law last summer, Scott was one of the first to seize on the court ruling that said states could opt out of the expansion of Medicaid, a key element of the reform.
As recently as December, Scott talked about the potential financial impact of the expansion - although the federal government will pay all the expansion costs in the first three years, eventually dropping to 90 percent by 2020.
"Growing government, it's never free," Scott told reporters after meeting with federal officials in January. "It always costs money."
But on Wednesday, Scott said he wouldn't try to block the expansion, joining a majority of other governors in opting in to the health-care reform plan and sorely disappointing conservatives who had counted on his opposition in the nation's fourth-largest state.
Once a darling of Tea Party activists, who played a critical role in his election in 2010, Scott's decision to embrace the Medicaid expansion puts him at odds with other conservative Republican governors - including Texas Gov. Rick Perry and Louisiana Gov. Bobby Jindal - who have rejected the option.
Scott's decision drew immediate fire from conservative activists.
"Will Medicaid expansion cover me for the knife (Scott) just buried in my back?" asked Henry Kelley, a Fort Walton Beach businessman and Tea Party leade, in a tweet shortly after Scott's announcement.
The conservative advocacy group Americans for Prosperity labeled Scott's move as "flip-flop."
Slade O'Brien, AFP's Florida director, cited Scott's long history in opposing the expansion of the federal-state health-care program.
"But today he came out in support of the Medicaid expansion he vowed to oppose," O'Brien said in a statement. "Hopefully our legislative leaders will not follow in Gov. Scott's footsteps and will reject expansion of this broken system."
Other critics characterized Scott's decision as another in a series of about-faces the governor has executed as he heads toward a 2014 re-election bid with abysmal popularity numbers among Florida voters.
After cutting education funding in his first year as governor, Scott has pushed for billions more in school funding, including a $2,500 teacher pay raise this year. After signing a law cutting early-voting days, Scott now wants to expand early voting after Florida became national laughingstock in the last election.
Scott dismissed claims that his Medicaid pivot was politically motivated. He said he is still worried that the "government-run" approach in the Affordable Care Act could lead to higher costs and lower care for patients.
But he also said the key decisions on the law were made by the U.S. Supreme Court last summer and the electorate in the November presidential election.
"This is the law of the land," Scott said.
Scott definitely struck a more conciliatory tone in his Medicaid announcement, saying the recent death of his mother gave him "a new perspective." Her struggles in the low-income family that he grew up in reminded him "no mother, or father, should despair over whether or not they can afford, or access, the health care their child needs."
"I cannot, in good conscience, deny Floridians access to health care," he said.
Scott did offer some pragmatic defenses of his decision, including the fact that he faced the option of having other states use Florida's tax dollars to expand their Medicaid programs or he could use the federal funding offer "to help some of the poorest in our state."
Scott also noted he would only agree to a three-year extension of the expansion, with the program facing a re-evaluation at the end of that time.
His announcement drew praise from some of his sharpest critics, including Democrats.
"This important choice by the governor will save lives in Florida," said state Sen. Eleanor Sobel, D-Hollywood, who noted that Scott was embracing the Democrats' argument that Medicaid expansion could bring health-care coverage to more than 1 million Floridians.
However, the ultimate decision on the expansion will be made by the Republicans who run the Florida Legislature. Senate President Don Gaetz, R-Niceville, and House Speaker Will Weatherford, R-Wesley Chapel, said Scott's decision will be taken into consideration, with Weatherford questioning whether Medicaid expansion will be good for the state.
"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 said in a statement.
Both the House and Senate have committees reviewing the impact of the Affordable Care Act and will make some recommendations during the legislative session that begins in March.
Another factor in Scott's decision as well as the Legislature's will be the Obama administration's approval of plans that allow Florida more flexibility in handling Medicaid patients.
Also on Wednesday, the federal government approved "in principle" Florida's plan to move most of its Medicaid patients into a statewide managed-care program, including HMOs. The federal government previously approved a similar move for Medicaid patients in long-term care programs.
Scott and legislative leaders contend that a statewide managed care system will provide substantial cost savings in the $21 billion state-federal health care program as well as improve care for some of the state's poorest and sickest residents. Critics have questioned whether the quality of care will suffer under a managed-care system rather than a fee-for-service system.
The timing of Scott's decision and the federal approval of the expansion of managed care for Florida's Medicaid program - under review for nearly two years - seem to be more than a coincidence. But lawmakers and Scott claimed there was no connection.
"I don't think there's any linkage," Senate President Gaetz said.
"There's certainly no linkage in my mind."