Commentary: Florida governor's about-face on Medicaid expansion

The Fort Worth Star-TelegramFebruary 22, 2013 

Florida Gov. Rick Scott did an abrupt about-face on Wednesday and said he has learned to love the foundation on which Obamacare was built, the expansion of Medicaid. He called it common sense.

"Quality healthcare services must be accessible and affordable for all-- not just those in certain ZIP codes or tax brackets," he said at a news briefing, according to an NPR report. "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."

That means beginning next year and at least through 2016, about a million people in Florida will be able to sign up for Medicaid's expanded coverage under President Obama's Affordable Care Act.

Less than a year ago, after the U.S. Supreme Court upheld Obamacare but said states cannot be forced to join the Medicaid expansion, Scott and Texas Gov. Rick Perry said their states would defy what they called the "massive entitlement expansion."

Now Scott has changed his tune, and pressure is building in the Legislature to get Perry to make the same switch.

Part of the reason the two were like synchronized swimmers last year was that they are Republican stalwarts who were supporting Mitt Romney's alternatives to Obama and his healthcare initiative.

Sometime after Romney lost the November election, Scott apparently had an epiphany.

"We have a Supreme Court decision, and we have an election that says this is the law of the land," he said Wednesday, again according to NPR.

So far, Perry won't budge. But an extensive lobbying effort pushed by hospitals, city and county government officials and church groups is ratcheting up the pressure on him.

Two of those groups, the interfaith alliance Texas Impact and Methodist Healthcare Ministries of South Texas, have released an authoritative study showing an enormous positive financial and healthcare boost from joining the Medicaid expansion.

About 2 million uninsured Texans would reap the healthcare benefit, says the report from Billy Hamilton Consulting. Hamilton has enormous credibility in Austin. For many years, he was the state's deputy and then chief deputy comptroller, and in that role he was the state's chief revenue estimator. The entire state relied on his numbers.

The key financial figure in the report: "The federal government would pay about $100 billion toward this expansion over 10 years, with the state responsible for only about $15 billion under a moderate enrollment scenario."

There is every reason for city and county government officials and hospital executives across Texas to support the Medicaid expansion.

More than 6 million uninsured people live in Texas, 23.8 percent of the population. That's the highest percentage in the nation, and it compares to an average of 15.7 percent uninsured nationwide.

Hospital district taxpayers and individual hospitals currently pick up the tab when many of those people can't pay their bills, a cost of at least $4 billion a year. Under Medicaid expansion, most would be covered. That's a heavy load lifted from the hospitals.

The Affordable Care Act says the federal government will pay 100 percent of the cost of expanded coverage for three years beginning in 2014. After that, the bill says the feds would cover 95 percent of the cost.

That's where Florida's Scott left himself an escape plan. He said his state would join in "while the federal government is committed to paying 100 percent."

Perry has sought federal dollars for many uses -- think disaster aid, for example. Federal taxes paid by Texans stay unchanged, but more comes back for their benefit.

It would be the same with expanded Medicaid.

Mike Norman is editorial director of the Star-Telegram.

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