In a blow to Republican Gov. Rick Scott, the Florida House Select Committee on Patient Protection and the Affordable Care Act voted along party lines March 4 to reject a proposal to expand Medicaid in the state. The committee’s 10-5 vote does not close the door on Medicaid expansion in this legislative term, but it sends a strong message expansion proponents have their work cut out for them if they are going to steer such a bill through the legislature.
Scott Champions Expansion
Gov. Scott surprised many political analysts in February when he announced he supported Medicaid expansion, which supplements the federal Patient Protection and Affordable Care Act, known as Obamacare. Under last year’s Supreme Court decision, each state will decide whether to expand its Medicaid program to facilitate Obamacare. For Medicaid expansion to occur in Florida, the legislature would have to approve a bill and Scott would have to forego a veto.
Nearly 20 percent of Floridians are already on Medicaid. The Scott administration projects expanding the program to approximately 25 percent of Floridians, as advocated by the Obama administration, would cost state taxpayers $5 billion during the next 10 years, and federal taxpayers (including Floridians paying federal taxes) an additional $45 billion during that period.
Scott aggressively championed the Medicaid expansion during his March 5 State of the State address.
“Our options are either 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 improvement,” said Scott.
“As I wrestled with this decision, I thought about my Mom and her struggles to get my little brother the care he needed with very little money. I concluded that for the three years 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 argued.
Still Lacking Votes
Legislative Democrats appear united in their support of Medicaid expansion, but Republicans hold strong majorities in the Florida House and Senate. Democrats need several Republicans in both the House and Senate to support the expansion in order for it to become law. Conservatives in Florida and other states are nearly united in their opposition to “Obamacaid,” a fact which has not changed despite Scott’s defection.
Political insiders told Health Care News there appear to be several liberal Republicans willing to join Democrats in supporting the Medicaid expansion and that the real drama is in the more conservative House, which could stand in the way of an expansion bill.
Tom Lauder, a reporter for Media Trackers Florida, which is closely following the Florida Obamacaid debate, says House Republicans appear likely to stand firm.
“Sources very close to the Republican leadership tell me Obamacaid supporters are not close to luring enough House Republicans to pass a bill,” said Lauder. “Also, Senate Republicans are unlikely to stick their necks out for President Obama and Gov. Scott and vote for Obamacaid unless they know the House will vote similarly.”
In Florida, before the full House can vote on a Medicaid expansion bill, a House Committee must draft and approve such legislation. Lauder notes the vote in the House Select Committee halted the Medicaid legislation this year, and he said signaled that even if expansion supporters somehow get a bill to the full House floor, Republicans will likely reject it.
“Grassroots conservatives are very active pressuring Republican legislators not to pass Obamacaid, and Republican legislators are taking notice,” said Lauder.
Conservatives Standing Firm
Lauder says Scott’s position has placed him at odds with his former supporters in the conservative base.
“Grassroots conservatives are particularly upset with Gov. Scott using the language of the left in his efforts to build momentum for Obamacaid,” Lauder explained. “When Scott argues, ‘I cannot, in good conscience, deny the uninsured access to care,’ he asserts that the only time people have access to goods and services is when government gives it to them as an entitlement. Scott has enraged his conservative base by making this big-government argument. This isn’t a question of whether government should give Medicaid to the poor and disabled, because the poor and disabled already qualify for Medicaid.”
At issue, Lauder says, is the rejection of Scott’s argument that federal funding will come without cost to state taxpayers.
“Scott’s conservative base also resents Scott talking about federal funding as if it were free money,” Lauder added. “Even if the federal government kept its promise to fund most of the Florida Medicaid expansion, which many conservatives doubt will be the case, Floridians pay federal taxes in addition to state taxes. Federal dollars flowing into Florida are not free dollars, even for Floridians. Plus, Florida conservatives, like conservatives in other states, realize that our ballooning federal debt is unsustainable. They worry about their country. If we can’t pay our bills with 20 percent of Floridians on Medicaid, how can we pay our bills with 25 percent of Floridians on Medicaid?”
Still in Play
The state legislature is in session through the first week of May, meaning proponents of Medicaid expansion will have more opportunities to present a bill and steer it through the House. Conservatives will have to hold firm against legislation throughout the legislative session to keep it from becoming law, because those who favor Medicaid expansion need only a single legislative victory to make it the law of the state.