Republican Gov. Rick Scott’s announcement last week that he supports the Medicaid expansion in Florida may not be enough to seal the deal. That’s because it still needs budget approval from the overwhelmingly Republican legislature, which has majorities of 28-12 in the Senate and 74-46 in the House, and is wary of going along with one of the key provisions of “Obamacare.”
Florida’s House Speaker Will Weatherford (R) told National Review he’s “personally skeptical that this inflexible law will improve the quality of health care in our state and [e]nsure our long-term financial stability.” He said the legislature, not the governor, will have the final word.
Democrats are taking the threat seriously.
“I’d say this threat from leadership is credible,” a senior Florida Democratic official told TPM. “Rick Scott is a Governor with a rock-bottom approval and that spells trouble for his legislative agenda. It’s unlikely they will thwart his will but not out of the question. They are already sending signals that they plan to challenge his agenda on other issues like increasing teachers’ pay. He just might not have the juice to get it done.”
The decision by Scott — whose fiery opposition to Obamacare was the main factor in his rise to prominence — was a huge blow to the “repeal Obamacare” movement. Under pressure from conservatives, he initially turned down the expansion, but reversed course last week amid low approval ratings and the lure of a stockpile of federal cash to help his constituents.
“While the federal government is committed to paying 100 percent of the cost of new people to Medicaid, I cannot, in good conscience, deny the uninsured access to care,” he said.
Authorized under the Affordable Care Act, and made optional by the Supreme Court in the landmark health care reform ruling last summer, the expansion would permit residents up to 133 percent of the poverty line to enroll in Medicaid. It’s a generous deal: the federal government would cover the full cost for three years and 90 percent thereafter.
Another factor in Scott’s change of heart: a vigorous push from hospitals, which would be on the hook for lower-income patients who are entitled by law to emergency care even if they’re unable to pay for it. Under the expansion, Medicaid would cover more of them.
“Politicians like to get re-elected, right?” observed a hospital industry lobbyist.
Ultimately, Scott and Republicans in the legislature have different political incentives. Scott is up for reelection next year and accepting federal cash to insure his residents is an irresistible proposition. But Republicans in the Legislature have little to gain by going along with the expansion. The Republican base remains strongly opposed to the law and conservative advocates see the Medicaid expansion as the last line of defense against the law.
Sahil Kapur is a congressional reporter for TPM. He previously covered politics and public policy for numerous publications including The Guardian and The Huffington Post. He can be reached at sahil [at] talkingpointsmemo.com.