A little more than two years ago, Florida Gov. Rick Scott made an announcement that shocked the political world: the Republican, who had spent a portion of his personal fortune to oppose Obamacare when it was being drafted in Congress, now supported expanding Medicaid in his state.
And it wasn't just the policy announcement itself. It was the emotional way in which Scott described his conversion from Obamacare hater to Medicaid expansion supporter, speaking about the loss of his mother just months earlier. Expanding Medicaid to nearly 1 million low-income adults was just a matter of doing what's right, he said in February 2013.
"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," said Scott, a former chief executive of the nation's largest for-profit hospital chain. Scott advocated a temporary three-year program that could be reversed in case the federal government reneged on its funding promise.
But the Florida state legislature didn't go along, passing up tens of billions of dollars in federal support. Florida is one of 22 states that haven't joined the Medicaid expansion.
And yet the Florida legislature now appears to be reconsidering its stance, or at least debating it again.The Senate has passed a budget that includes federal expansion funding, but the plan faces stiff opposition in the House, which shut down the expansion two years ago. And Scott's administration is in talks with federal health officials to extend a $2 billion funding pool for health-care providers treating uninsured residents. Those providers receiving funds from what's known as the Low-Income Pool (LIP) would presumably benefit from expanded Medicaid. The Obama administration, which wants every state to expand Medicaid, has said it won't continue LIP funds beyond this June.
Amid these discussions, Scott now says he opposes the Medicaid expansion. Citing the LIP negotiations, Scott issued a statement Monday that he doesn't think the federal government will live up to its funding promise, the Associated Press reported. The federal Department of Health and Human Services pushed back in a Monday statement, saying that "the law is clear" on how much support the federal government must provide for the Medicaid expansion.
In a way, Scott's change of heart isn't all that surprising. After giving that emotional speech more than two years ago, Scott didn't campaign for expansion or pressure lawmakers from his own party. Meanwhile, two Republican governors, John Kasich of Ohio and Jan Brewer of Arizona, made full use of their executive powers to expand Medicaid in their states (and faced lawsuits from state lawmakers because of it).
During last year's gubernatorial election in Florida, the Democratic candidate Charlie Crist made Scott's inaction on the Medicaid expansion a central part of his losing campaign. Scott tried to avoid the issue during the race, which he barely won in November. But Scott can no longer avoid the topic since it's become a central issue in the state legislature's debate over the budget.
So why did Scott support a Medicaid expansion in his state in the first place?
Hours before Scott announced his original support for the Medicaid expansion in 2013, the federal government granted permission for the state to enroll nearly all its existing Medicaid patients in private managed care plans, something Florida lawmakers had wanted for years. "This is a great win for Florida," Scott said at the time.
Both Scott and federal officials at the time denied there had been a quid pro quo.
But whatever Scott's reasons were then, it's clear that they weren't strong enough for him to see through a Medicaid expansion in his state. And now that he's officially come out against it, Florida is less likely to see a Medicaid expansion that would help insure nearly 1 million poor people.
This post has been updated with statements from HHS and Scott's office.