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Florida’s Rick Scott: I Won’t Expand Medicaid

Florida Governor Rick Scott has explicitly rejected the Medicaid expansion as part of the Affordable Care Act, threatening the coverage of 951,622 low-income Floridians.

“Florida is not going to implement Obamacare. We are not going to expand Medicaid and we’re not going to implement exchanges,” Scott’s spokesman Lane Wright told The Associated Press on Saturday. Wright stressed that the governor would work to make sure the law is repealed.

Scott told Fox News the Medicaid expansion would cost Florida taxpayers $1.9 billion a year, but it’s unclear how he arrived at that figure.

Scott said the state will not expand the Medicaid program in order to lower the number of uninsured residents, nor will Florida set up a state-run health exchange, a marketplace where people who need insurance policies could shop for them.

“We care about having a health care safety net for the vulnerable Floridians, but this is an expansion that just doesn’t make any sense,” he told Fox host Greta Van Susteren.

This is a key point. Scott and his confreres will simply lie about the costs to the state from the Medicaid expansion. The federal government is slated to pick up 100% of the costs over the first three years of the expansion, but in Rick Scott’s hands, it’s a $1.9 billion expense (where “your money” goes to pay for health care for those lazy poor people). Keep in mind that the Florida Agency for Health Care Administration, which has wildly inflated the number of new enrollees from the expansion (to 1.95 million), says that it will only cost the state $2.4 billion between 2013 and 2018 cumulative. However, the point is that it will not be so clear-cut, and it will devolve into a he said/she said mess. I simply don’t trust the media to work that out for people in any satisfactory way.

Anyone who thought the man whose first foray into the political arena was to set up a front group called “Conservatives for Patient’s Rights” devoted to defeating Obamacare would meekly assent to expanding Medicaid has to have their head examined. Scott has plenty of experience turning away federal dollars, particularly for high speed rail, but also some early Affordable Care Act grants.

For some reason, health care experts continue to walk out on a limb and claim that this will have a minimal impact. That’s head-in-the-sand thinking. It will take defeating Rick Scott in Florida to expand Medicaid. He will never expand it by himself. And this is the guy who will spend every day between now and that 2014 re-election campaign purging Dem-leaning voters from the rolls. I wish that was a conspiracy theory.

For those who think that Democrats can make political hay out of this issue, I don’t really see why. Medicaid is nominally popular, but given how the issue will be framed, why would the middle-income people who vote want to spend their tax dollars on free health care for poor people? Mitch McConnell’s remarks this weekend on Fox News, where he said that 30 million uninsured “are not the issue,” may not play well nationally, but to conservative audiences, it’s not so clear-cut. They will hear that the federal government wants to take over health care, and they want to spend your money on undeserving poor people to do it.

The fight for expanding health coverage now moves squarely into the political arena in a handful of states. Medicaid’s use toward nursing home coverage may make it a special case in Florida and it’s high elderly population. There could be some politics to play there. But Florida is downright favorable terrain compared to places like Texas and Nebraska and Mississippi and the Plains states.

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David Dayen

David Dayen