TALLAHASSEE — Florida Gov. Rick Scott, a staunch opponent of the health care overhaul championed by President Barack Obama, said Friday that he doubts the state can afford the Medicaid expansion called for by the plan but that the Supreme Court has found to be optional.
Scott must decide whether or not he will support expanding the state’s Medicaid program in order to lower the number of uninsured residents.
The U.S. Supreme Court, while upholding the overhaul on Thursday, ruled that Congress cannot withhold federal Medicaid funding from states that opt out of a requirement in the overhaul to expand coverage to those just above the poverty line.
On the day of the ruling Scott was cautious about the expansion, saying he wanted to read the ruling first. Then during an interview Friday morning on a Jacksonville radio station, Scott said it was unlikely he would go along with the expansion because of the potential cost to the state.
“I don’t know how we are ever going to be able to afford it,” Scott said on WOKV. “Look at how tough our budgets are now.”
But the governor told the Tampa Bay Times later in the day following an appearance in Tampa that he was still evaluating the ruling and would come up with a plan in the next few weeks.
Scott, the former CEO of a hospital chain, has been a vocal critic of the health care overhaul from the start. He made his first foray into politics by forming a group called Conservatives for Patients Rights that ran television ads criticizing the proposal before it was adopted by Congress.
Scott has also complained about the growing cost of Medicaid, the $21 billion safety net program that primarily aids the poor but also picks up nursing home bills for senior citizens. The governor backed a push by the Republican-controlled Legislature to shift Medicaid patients into managed care programs, an effort which is still awaiting federal approval.
Scott has rejected federal money in the past, most notably
$2.4 billion for high speed rail. His administration has also said no to some money attached to the Affordable Care Act.
But at the same time Scott has said yes to money associated with the federal stimulus program and he has changed some of the positions he advocated during his run for governor. Scott also must weigh the political calculations of saying no to Medicaid because of tight budgets, while it is likely he will continue to push for substantial tax cuts between now and his reelection campaign in 2014.
State Sen. Nan Rich, a Democrat who has already announced she will challenge Scott, said it would be inconceivable for the governor and the Legislature to refuse to go along with the Medicaid expansion.
“It’s a no-brainer as far as I’m concerned that we would want to be a part of expanding Medicaid and take a million people off the uninsured rolls,” Rich said.
According to Census data released last year, Florida had the nation’s third-highest rate of residents without health insurance during the past three years.
President Obama’s health care law called for states in 2014 to expand eligibility of Medicaid to those making up to 133 percent of the poverty level, or $29,326 for a family of four. While estimates vary, the Florida Agency for Health Care Administration has concluded that as many as 1.95 million more people would join Medicaid and other state-subsidized health insurance programs over the next five years.
Most of the billions this would cost would be absorbed by the federal government. The Medicaid expansion would not cost the state anything until 2017 — although AHCA estimates that changes to other state-subsidized programs would require state money starting in 2014. AHCA estimates that the overall cost to the state would be
$2.4 billion between 2013 and 2018 with the federal government picking up nearly $26 billion.
But other groups analyzing the potential changes contend that state officials have “hyper-inflated” the potential costs because they assume too many people will enroll.
The ultimate choice, however, won’t be Scott’s alone. It will also be decided by the Legislature.
State Sen. Joe Negron, a Stuart Republican who oversees health care spending for the state, said he’s not inherently opposed to expanding Medicaid. But he said he remains concerned that the “generous” terms of initial federal support will give way to a larger and larger cost for the state government.
Plus, he said that he’s not sure that the Medicaid program should be used as a way to reduce the ranks of the uninsured. He said he views Medicaid as a program to help the most vulnerable.
“I personally believe Medicaid should be a last resort safety net,” Negron said.
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