When Florida’s governor, Rick Scott, decided in February to sign on to Obamacare’s expansion of Medicaid, he made a much bigger splash than the other six GOP governors who have made the same decision.
It was a complete reversal of the pledge Scott made last summer after the Supreme Court upheld the law: “We’re not going to expand Medicaid, because we’re going to do the right thing.” The stunning nature of his flip-flop has invited comparisons to his predecessor Charlie Crist, the Republican-turned-independent-turned-Democrat who developed a reputation for being as flexible in his principles as Gumby.
In reality, Scott remains a conservative Republican, although he has lurched to the left, perhaps in an attempt to improve his anemic 38 percent approval rating in time to run for reelection in 2014. However, the maladroit manner of his reversal could turn him into the next George H. W. Bush, who broke his “no new taxes” pledge before his 1992 presidential-reelection campaign. That opened Bush up to a conservative primary challenge, the independent candidacy of Ross Perot, and a stinging defeat in the 1992 general election by Bill Clinton. Ironically, what may save Scott from a similar fate is that his conservative GOP legislature seems primed to turn down his Medicaid expansion. Scott may look weak if he is rebuffed, but he can then blame his failure on the legislature and avoid the fallout from the coming collapse of Obamacare, which is quickly becoming an administrative nightmare.
The danger for Scott is that, unlike other GOP governors who have accepted the Medicare Trojan horse offered by the federal government, he is powerfully identified with opposition to Obamacare. A former CEO of a medical-care company, he spent millions in independent-expenditure ads against Obamacare and then launched a campaign for governor in 2010 that was built on the publicity he won from those ads. He narrowly defeated then–Florida attorney general Bill McCollum in the GOP primary by painting him as a moderate even though McCollum was the first state attorney general to challenge Obamacare in court. In narrowly defeating Democrat Alex Sink in the fall, he spent $73 million of his own money, much of it going to warn voters that Sink would saddle the state with Obamacare.
As governor, Scott implemented needed budget cuts but began to lose support with a series of clumsy maneuvers and rhetorical gaffes. When his approval ratings began to fall, he tried to recover by embracing government programs such as a commuter-rail system in Orlando and a $2,500 pay raise for teachers. But his latest reversal was a critical break with his base. “With his Medicaid decision, this week, Scott officially and forever cast off his image as a tea party standard-bearer,” the Tampa Bay Timesconcluded.
What was surprising is that so many of his fellow GOP leaders were quick to distance themselves from his decision. Many were furious that Scott had given them only five or ten minutes of notice on his reversal of position before he made it public.
Agriculture commissioner Adam Putnam was quick to refer to his service in Congress in casting doubt on Scott’s statement that he was expanding the program for only three years and might not renew it if reelected. “It is naive at best to think that you would enroll 1 million people in three years and then decide to walk away from the program,” Putnam told reporters. “I think we all have an obligation to look beyond the window of our own time in public life and think about the long-term impact of these policies on Florida.”
But Florida house speaker Will Weatherford placed the biggest potential roadblock in front of Scott’s plan when, within ten minutes of Scott’s announcement, he proclaimed: “The Florida legislature will make the ultimate decision. I am personally skeptical that this inflexible law will improve the quality of health care in our sate and ensure our long-term stability.”
Within days of Weatherford’s statement, and while Scott was out of town, former Florida governor Jeb Bush visited the state capitol in Tallahassee; Bush urged Republican legislators there to create an alternative plan instead of expanding the Medicaid system. After the meeting with Bush, state representative Richard Corcoran, who chairs the House committee implementing Obamacare, described his response to Scott’s proposal: “Skeptical would be a nice way to describe where I stand.” Even some Democrats were dubious: State representative Jose Javier Rodriguez of Miami told reporters, “One of the fears . . . is that . . . Florida would not be able to sort of scale back our commitment to the expansion population.”
Governor Scott may try to scale back his proposal in order to avoid a humiliating defeat at the hands of his own party’s legislative leaders. But skeptics of his plan would be wise to resist any Medicaid expansion. In 2011, the GOP legislature privatized the operation of Medicaid after numerous reports that the program was delivering substandard medical care. The federal government has yet to grant a final waiver approving the privatization request.
Expanding Medicaid in Florida before the legislature’s reforms have even begun to be implemented could torpedo any hope of stabilizing the program. The federal money for Medicare may seem “free,” but it comes with a poison pill: Under expansion, hospitals will have more patients whose care is compensated at below-cost rates, which will lead to cost-shifting that will further drive up insurance costs for those with private insurance.
But Grace-Marie Turner of the Galen Institute, a free-market health-care think tank, says, “The worst thing about expanding Medicaid is that it will condemn millions more citizens to a program that can be worse than being uninsured.” She notes that fully half of all doctors now decline to see Medicaid patients and that expanding the program “will make it even harder for those on Medicaid to find a doctor to see them when they will be forced to compete with millions more people who have been added.” By 2016, one in four Americans is likely to be covered by Medicaid.
It’s time to stop the madness. Instead of succumbing to the lure of Obamacare’s “free” money, Governor Scott should demand that Washington give him the flexibility to fix the broken program and adapt it to Florida’s needs. Scott Gottlieb, a clinical assistant professor at New York University’s School of Medicine and a former deputy commissioner at the FDA, told the Wall Street Journal recently that he doesn’t underestimate the challenges posed by that approach. Gottlieb said that reform has “been a nonstarter with an Obama health team so romanced by Medicaid’s cozy fictions that it neglects . . . the indecencies it visits on the poor.”
Governor Scott began his political career by calling Obamacare “the biggest job-killer ever.” He promised he would “do the right thing” by not expanding the substandard Medicaid program. He apparently is no longer willing to do the right thing, so now it will be up to House Speaker Weatherford and other Republican legislators to save him from himself.
— John Fund is national-affairs columnist for NRO.