Before he was Florida's governor, Rick Scott sank $5 million of his own fortune into trying to kill President Barack Obama's health care reform agenda. On Wednesday, Scott, a Republican, completed a major turnaround when he announced his state would take part in a key element of Obama's plan to enroll more poor people in Medicaid.
Florida will expand its Medicaid program to anyone who earns up to 133 percent of the federal poverty level, which is $15,282 for a single person this year, Scott said Wednesday afternoon during a news conference in Tallahassee. Scott is now the seventh Republican governor to back the Medicaid expansion made possible by Obamacare. In addition to Florida, 22 states and the District of Columbia plan to broaden Medicaid.
"I want every Floridian to have access to high-quality health care they can afford," Scott said.
The governor proposes Florida expand Medicaid under Obama's health care reform law for at least the next three years, when the federal government will pay the full cost of enrolling newly eligible people. "While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care," Scott said.
Under the health care reform law, the federal government covers all the expenses for insuring newly eligible people from 2014 through 2016. That share declines over several years until it reaches 90 percent in 2022 and beyond. Nevertheless, 13 Republican governors already have rejected the Medicaid expansion. Many of those governors are Scott's neighbors in southern states from North Carolina to Texas.
Expanding Medicaid would enable Florida to make a dent in its large uninsured population. One-fifth of Floridians, or about 3.8 million people, had no health insurance in 2011, according to census data compiled by the Henry J. Kaiser Family Foundation. Only California and Texas had more uninsured residents. Florida's 20 percent "uninsurance" rate is tied for the fourth-worst and trails Texas, Nevada and New Mexico. The GOP governors of Nevada and New Mexico also support the Medicaid expansion while Republican Texas Gov. Rick Perry remains opposed.
About 1.3 million people in Florida would gain health benefits under a Medicaid expansion, according to an analysis issued in November by the Urban Institute and the Henry J. Kaiser Family Foundation. Florida would spend $5.4 billion through 2022 and receive $66.1 billion from the federal government over that period to fund the expansion, the report says.
Perhaps more so even than his fellow Republican Govs. Jan Brewer of Arizona and John Kasich of Ohio, Scott appeared the least likely to cooperate with the Obama administration. A former hospital executive, Scott founded Conservatives for Patients' Rights to fight Obamacare and was outspoken against the law during his 2010 campaign for governor.
Florida also spearheaded the 26-state legal effort to repeal Obama's health care reforms. The lawsuits made it all the way to the Supreme Court, which upheld the law but gave states the option to refuse the Medicaid expansion, a possibility Congress did not envision.
Following the Supreme Court ruling, Scott declared Florida wouldn't participate in the Medicaid expansion. After Obama won a second term, however, Scott began to soften his rhetoric and met with Health and Human Services Secretary Kathleen Sebeilus to discuss finding common ground on the implementation of the health care reform law in Florida.
Obama's reelection and the Supreme Court ruling make Obamacare the new reality, Scott said Wednesday. "I believe in a different approach but it doesn't matter what I believe. It doesn't matter what anyone believes."
Scott and other Florida policymakers also have been under pressure from powerful health care interests to take part in the Medicaid expansion. At a Florida House of Representatives hearing Monday, hospital industry representatives sought to persuade legislators that extending health care coverage to more people was crucial to their bottom lines.
Scott sought flexiblity from the Obama administration on Medicaid and may have found it earlier Wednesday, when the federal government tentatively approved changes to Florida's Medicaid program that have been a priority for the governor's administration. Final action by the federal Centers for Medicare and Medicaid Services would enable Florida to move ahead with its plan to enroll more of its Medicaid beneficiaries in private health plans. Scott said his decision on the Medicaid expansion, however, wasn't contingent on the federal action.
Scott cautioned Florida should only commit to broadening Medicaid for the first three years of the expansion, which would then need to be reauthorized, and said it should be scaled back if the federal government were to reduce its share of the spending during 2014 through 2016. The Obama administration has vowed to oppose any future cuts to Medicaid funding.