Rick Scott’s about-face

Will his reversal on Medicaid lead to a challenge from his own party?

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Hillsborough County House Republican Jamie Grant said a central question for him is whether it should be Washington or Tallahassee that decides what’s best for Floridians’ healthcare needs, and seems to be leaning against expansion. “I tend to believe that we as a state could put into place an alternative that would be much better care at a much better rate.”

Grant’s GOP colleague Dana Young, who represents parts of Tampa in Tally, says that she has seen little in the ACA’s initial phases that would lower costs and increase quality. Nevertheless, she insists she has an open mind and will rely on a committee’s report before making what she believes will be one of the most important decisions any legislature has made in decades.

“This just doesn’t affect our children, but our grandchildren, and frankly it affects the overall economy for the state of Florida for generations,” she says.

Pasco County House Republican Mike Fasano says he strongly supports Medicaid expansion. He touts the same reason that other health care advocates do — that it will create jobs and keep people out of emergency rooms, “but the best reason is because it’s the right thing to do,” adding that “we can’t allow people in our society, in our community and our state not to have at least access to primary care.”

Representative Matt Gaetz tweeted last week that “a few days at home confirms that FL Legislators who vote to expand Medicaid are going to have real problems getting re-elected.”

An estimated 1.3 million uninsured Floridians could be expected to enroll in coverage under Medicaid expansion by 2020 if the Legislature approves the plan, which dictates that the federal government pay the full cost of Medicaid expansion for the first three years, and 90 percent of the cost after that.

The Henry J. Kaiser Family Foundation has estimated that, while this could cost Florida $5.4 billion over the next decade, the state would gain $66.1 billion in federal healthcare payments over the same time.

The Supreme Court ruled last year that, although the law was constitutional, states could choose not to expand their programs. And Governor Scott didn’t completely capitulate in agreeing to expand Medicaid. In fact, Health and Human Services Secretary Kathleen Sebelius granted Scott a waiver to move more Medicaid patients into private managed-care plans.

Although advocacy groups like Florida CHAIN blasted the state’s experiment with privatizing Medicaid back in the Jeb Bush era, the group’s executive director Laurie Goodhue says the ACA includes changes that make the waiver a better situation. She refers specifically to consumer protections. “It’s actually come a long way from where we started from under the Jeb Bush plan.”

That pilot program initially began in Broward and Duval counties in 2006 and expanded into three other counties near Jacksonville the following year. Though Florida CHAIN and other groups have blasted HMOs for “delay and deny tactics,” a report issued in December of 2011 by the University of Florida highlighted improved access for consumers, higher scores in quality measures, and taxpayer savings.

But in a report issued earlier in 2011, researchers at Georgetown University declared that there was no clear evidence that the pilot programs were saving money, and if they were, it was inconclusive if those savings were generated by efficiencies or at the expense of needed care.

For all the complications of the ACA, its main premise is simple — to get more Americans without insurance on the rolls. And that’s why Medicaid in Florida will be streamlined in terms of those who are eligible. Currently Laura Goodhue says you have to be “very poor, a child, a pregnant woman, a senior, or a person with disabilities” to qualify. But in the future the eligibility requirements will be simpler. “The ACA envisions a welcome mat, not a door,” Goodhue says.

So as the Legislature convenes this week in Tallahassee, no vote looms larger than on Medicaid expansion. Over a million uninsured Floridians stand to gain access with their assent.

Meanwhile Paula Witthaus challenges state legislators who have healthcare protections to think about those who don’t. With their “Humana, their Aflac, and all of the insurance,” she says, “they have to realize that people are out here dying.”

And Governor Scott? For all the backbiting among Republicans, a private Politico poll conducted by Democratic pollster David Beattie showed last week that his approval ratings (48-47 percent) were no longer underwater. The survey was taken after his announcement about giving $2,500 bonuses to all public school teachers. And if the worst criticism he gets from his former supporters is that his new moves are all about getting re-elected, it begs the question: Who is more in line with the mainstream Florida voter — Scott and the Democrats who support his changes of heart, or Jeb Bush, Putnam, Bondi and the rest of the RPOF establishment?

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