When the Supreme Court ruled that states could opt-out of the Affordable Care Act's Medicaid expansion, Florida Gov. Rick Scott (R) was one of the first to volunteer.
“Florida will opt out of spending approximately $1.9 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program,” his office wrote in a statement issued last July.
That makes Gov. Scott's endorsement of the Medicaid expansion this afternoon all the more remarkable. It comes from one of the most ardent opponents of the Affordable Care Act—and would single-handedly add 1.3 million Floridians to the law's insurance expansion.
"I believe in a different approach," Scott told reporters at a late Wednesday press conference. "But it doesn’t matter what I believe. The Supreme Court made its decision We had an election in the fall and the public made their decision. Now the president's health care law is the law."
Scott is the seventh Republican governor to come out in support of the Medicaid expansion, following high profile decisions by Ohio Gov. John Kasich and Arizona Gov. Jan Brewer.
Florida will not operate its own health insurance exchange, instead leaving that task to the federal government, alongside 25 other states.
Scott came out of the gate as one of the health law's most vigorous opponents. His state led the Supreme Court challenge to the president's signature legislative accomplishment.
After the president's reelection, which secured the Affordable Care Act's political future, Scott's stance changed. He had a number of meetings with Health and Human Services Secretary Kathleen Sebelius on the provision and announced a new openness to the implementing the law.
"This is a very significant decision because there is so much at stake here," Joan Alkers, Co-Executive Director at the Georgetown Center for Children and Families, says. "There is coverage for over a million people and the federal dollars coming into the state are pretty much as many as any state could get. They really have got the most to gain."
Florida has 6.1 million uninsured residents. The Urban Institute projects that 1.3 million would gain coverage through this Medicaid expansion.
Under the proposal that Scott laid out, the Medicaid expansion would not be permanent, but rather sunset after three years, giving the state a chance to reevaluate the program in 2017.
"We will support a three year expansion under the new health care law, as long as the federal government meets its commitment to pay 100 percent of the cost during that time," Scott says. "After three years, it would need to be reauthorized."
Scott's expected endorsement of the Medicaid expansion comes after the federal government approved the state's request for two waivers in the entitlement program. That would allow Florida to scale up its managed care program, under which private companies administer Medicaid benefits, statewide.
Scott told Sec. Sebelius that, in order for the state to move forward on the expansion.
"For us to make a decision where we go forward, we've got to get these two waivers done," Scott recounted telling the HHS Secretary in January.
The question now is what happens in other Republican states: Will Florida convince other holdouts to sign up? It's also worth noting that this decision must survive the Republican-controlled legislature, which would have to sign off on putting any funds towards the Obamacare provision.