IT HAS always been irrational for states to decline to expand their Medicaid programs under the Affordable Care Act. The 21 states that have refused to take advantage of this element of Obamacare have denied access to coverage for 4 million people, left billions in federal health-care dollars on the table and thrown the financial fate of their hospitals into doubt.
But Florida Gov. Rick Scott (R) is taking irrational to new lengths. Mr. Scott ordered state agencies Thursday to prepare for a possible shutdown on July 1 because Tallahassee can’t agree on Medicaid expansion, which the state Senate favors and he and the Florida House oppose. At the same time, Mr. Scott is doing battle with the Obama administration, which has warned that the future of a federally funded program providing charity care to indigent Floridians is linked to whether the state expands its Medicaid system. Mr. Scott announced he will sue the Health and Human Services Department, arguing that the feds are coercing the state “further into Obamacare.”
The governor is right about that. But the administration is right to do so. Mr. Scott is wrong on just about everything else connected with this fight, and both the Obama administration and the Florida lawmakers who favor Medicaid expansion have reason to pressure him.
HHS is essentially prodding Mr. Scott to replace the old indigent care program he favors, which HHS concluded two years ago has major problems, with wider Medicaid coverage, which is a better way to care for the needy. In those states that have expanded their Medicaid systems, wider coverage appears to have lowered the amount of money needed to compensate hospitals and clinics for uncovered patients who can’t pay for required health-care services. Better then to use federal money to provide patients with real health coverage, rather than maintain the obsolete indigent care program. The Supreme Court has declared that states are free to refuse Medicaid expansion. But state leaders can’t expect the federal government to keep less effective programs in place because, out of ideological fervor or political calculation, Republican politicians will not accept better ways to care for indigent patients.
The GOP-controlled Florida Senate, meanwhile, has a plan that would take the federal Medicaid expansion money, use it to help low-income people buy private insurance and maintain a piece of the indigent care program to cover any uncompensated costs hospitals still face. The federal government has signaled that it would accept such a plan. Mr. Scott and Florida’s House, which also has a Republican majority, should help put it into effect instead of fuming and fussing and threatening to shut down the government.
In fact, every Republican state leader, including those in Virginia, should accept the evidence and allow their constituents to benefit from Medicaid expansion. Their battle against common sense has gone on long enough.