Affordable Care Act cleared another hurdle toward implementation

President Obama’s Affordable Care Act cleared another hurdle toward implementation Wednesday when one of its fiercest opponents, Florida Gov. Rick Scott, embraced a key pillar of the law by voicing support for its critical Medicaid expansion component.

Scott joins six other Republican governors who have recently come to back a provision meant to extend coverage to 17 million Americans nationwide.

“I believe in a different approach,” Scott told reporters at a news conference Wednesday. “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.”

Florida, a key state because of its size, decided Friday that it would not operate its own health insurance exchange, a new marketplace mandated under the law, leaving the task to the federal government. While the exchanges are meant to be online portals where consumers can compare and purchase health coverage, the Medicaid expansion would be a new insurance option for Americans who earn less than 133 percent of the federal poverty level, or $15,282 for an individual.

Legislators meant for all 50 states to expand Medicaid coverage, but the Supreme Court ruled that provision unconstitutional, leaving states to decide whether to sign up.

In Florida, analysts expect the Medicaid expansion to cover 1.3 million people and bring $73 billion in federal funds into the state over the course of a decade.

“This is a very significant decision because there is so much at stake here,” said Joan Alkers, co-executive director at the Georgetown Center for Children and Families. “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.”

Under the governor’s proposal, Florida would agree to participate in the Medicaid expansion for three years. The state would also reserve the right to withdraw from the program if the federal government cut its funding for the program, currently slated to cover all costs for the newly eligible Medicaid enrollees.

“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 said. “After three years, it would need to be reauthorized.”

Scott came out of the gate as one of the health-care law’s most vigorous opponents. His state led the Supreme Court challenge to Obama’s signature legislative accomplishment.

When the Supreme Court ruled that states could opt-out of the Affordable Care Act’s Medicaid expansion, he 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 in July.

After the president’s reelection, which seemed to secure the Affordable Care Act’s political future, Scott’s stance changed. He met with Health and Human Services Secretary Kathleen Sebelius on the the Medicaid provision and announced a new openness to implementing the law.

Scott’s 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.

Scott told Sebelius that in order for the state to move forward on the expansion, he would need to secure that additional flexibility.

“For us to make a decision where we go forward, we’ve got to get these two waivers done,” Scott recounted telling her in January.

Thirteen Republican governors have come out against the Medicaid expansion, while others continue to weigh their options. Virginia Gov. Robert F. McDonnell sent a letter to legislative leaders Wednesday ruling out a Medicaid expansion unless the Medicaid program undergoes “major reforms.”

“I cannot and will not support consideration of an expansion of Medicaid in Virginia . . . until we receive guarantees that the federal government’s promises to the states can be kept without increasing the immoral national debt,” McDonnell wrote.