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.
He says he had a change of heart after his Mom died and he remembered her struggles to get Hx care for his ailing brother.
I hate to be cynical but I suspect it is more closely related to his low ratings in the polls.
At any rate, I am glad all those ill and old folks will now get some help.
Like all first term governors with low ratings, he's looking to up his chances for a second term. Nobody I know, likes Rick Scott ---------he's a scum hopper from the word go, but Medicaid recipients are also voters, so he knows better than leave them in the dust........ I'd say most governors will end up doing this, if they are seeking re-election.
"Florida governor Rick Scott created a stir this week when he said he’d expand Medicaid as requested by the Obama administration -- even though he plans to defy the health reform law as much as he can.
But health policy experts are hardly surprised. They say it’s a no-brainer for even the reddest states to take the federal government up on its offer to pay for the expansion for the first few years.
That doesn’t mean all Republican governors will do it, however. A lot, they say, depends on what concessions these governors can get out of the Health and Human Services Department in return.
“It’s a lot of money when the feds pick up the tab for the first three years,” said Sarah Hale, who directs health policy at the right-leaning American Action Forum.
“That’s a really big deal. It’s hard for states not to take it,” she added. “In a lot of ways, it is a pretty big carrot.”
In fact, expanding Medicaid could generate revenue for the states, Topher Spiro of the left-leaning Center for American Progress says. "Many governors are realizing how good a deal it is," Spiro says.
The 2010 Affordable Care Act was designed to transform health care in the United States, which most experts agree currently costs too much and leaves far too many people without health insurance. The law required states to extend Medicaid to people earning up to about 138 percent of the federal poverty level, or about $14,800 for single people and $31,000 for a family of four.
The federal government calculated this would add at least 16 million people to Medicaid, the joint state-federal health insurance plan for the low-income.
In return, the law pledges that the federal government will pay 100 percent of the additional costs for the first three years of the program. States will have to kick in a very small percentage more each year after that.
But after a series of challenges to the law, the U.S. Supreme Court ruled in June that the Medicaid expansion requirement went too far. States can’t be forced to add more people to Medicaid, the court ruled.
Any smart governor is taking advantage of this flexibility, or should be, to negotiate deal with the administration on just how to expand Medicaid, several experts said.
“I think the states do have more leverage now than they used to,” said Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution.
"Many Republican governors have done a smart thing -- they are actually including in their proposals what they call a circuit breaker," Spiro said. "If at any future date the federal government lowers its share of the funding then the state would either automatically scale back the coverage or re-examine it."
Spiro adds that it would be unlikely this would happen. "It’s not going to be a bait and switch," he said, noting that President Obama has pledged the federal government will not scale back support of Medicaid.
Spiro also cites a Georgetown University study that projects Florida will gain $100 million a year by expanding Medicaid. "For example, many of these states have mental health care programs that they pay for themselves. With a Medicaid expansion, Medicaid would pay for mental health care," he said.
A different study done by Ohio State University, the Urban Institute and others projected Ohio could raise $857 million in additional revenue from 2014 to 2022 by expanding Medicaid.
"If you have got more Medicaid funding coming into the state and supporting hospitals, that’s going to increase jobs, it is going to increase economic activity and, as a result, the state is going to yield more tax revenues," Spiro said.
Conservatives are nonetheless suspicious..........."
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