After reversing themselves and endorsing the Affordable Care Act’s Medicaid expansion, three GOP governors—Arizona’s Jan Brewer, Florida’s Rick Scott and Ohio’s John Kasich—have tried to convince their Republican legislatures to enlarge their states' health care program for the poor. None of the three has succeeded so far, but they’re taking very different approaches to get what they say they want.
Scott was the most surprising convert. He first dabbled in politics when he created a political action group in 2009 to oppose Obamacare, and he spent more than $70 million of his own money in a gubernatorial campaign in 2010 that focused largely on attacking the president and his signature health reform law. Scott’s state was also the lead plaintiff in the U.S. Supreme Court case, on which Chief Justice John Roberts ruled that states must be able to choose whether or not to participate in the Medicaid expansion.
Then this February, Scott changed his tune, saying that he couldn’t deny the prospect of insuring one million Floridians and drawing down billions of dollars in federal funding.
He publicly urged the legislature to follow his lead, but in the weeks and months that followed, Scott refused to put much of his office’s clout behind the Medicaid expansion push. During the last week of the Florida legislative session, the governor was conspicuous in his absence, even as minority House Democrats staged a desperate protest to get majority House Republicans to join a compromise to which Scott and Senate Republicans had given their consent.
“I said yes to make sure we take care of the uninsured, and the legislature said no,” Scott said with a shrug when asked by reporters if he would lobby for for Medicaid expansion that week. Most statehouse sources told Governing that they didn’t think expansion was a significant priority for the governor. “It wasn’t his top two,” observed Republican State Sen. Aaron Bean, referring to Scott’s two stated legislative goals of a pay raise for teachers and a manufacturing tax cut (both of which he achieved).
The possibility of Scott calling a special legislative session to consider the Medicaid expansion again was floated even before the regular session ended, but Scott tells Governing he has no immediate plans to do so. That decision effectively eliminates the possibility of Florida expanding Medicaid in 2014.
"We just had a session. The sessions are not free. The Senate said yes, and the House said no. It was an adament no," says Scott. "I'm not gonna waste the money of the citizens of the state."
On the opposite end of the spectrum is Arizona’s Brewer. Like Scott, she reversed her longstanding opposition to the ACA to support Medicaid expansion in early 2013, but she has been much more forceful in her efforts to persuade Republican lawmakers to join her. More than 460,000 Arizonans would gain Medicaid coverage if eligibility were expanded to 138 percent of the federal poverty level, as the federal health reform law prescribes.
GOP legislators were resistant to agreeing to a major provision of a law they oppose, so Brewer threatened earlier this month to veto any legislation that came to her desk until they did—a serious public and political stand. Last week, she made good on that threat when she vetoed five bills while invoking the need to expand Medicaid.
“I warned that I would not sign additional measures into law until we see resolution of the two most pressing issues facing us: adoption of a fiscal 2014 state budget and plan for Medicaid,” Brewer wrote when issuing her vetos. “It is disappointing I must demonstrate the moratorium was not an idle threat.”
Somewhere in the middle is Ohio’s Kasich. Alongside Scott, he was a longstanding critic of Obamacare, and he was swept into office in 2010 with the Tea Party wave. But the federal money that comes with the Medicaid expansion and the opportunity to insure nearly 800,000 Ohioans overcame Kasich’s previously entrenched opposition.
But like Brewer and Scott, Kascih hasn’t had much luck convincing his conservative counterparts in the Ohio General Assembly to have a similar change of heart. He’s been more outspoken than Scott in pushing for the Medicaid expansion, but hasn’t gone as far as Brewer by issuing a veto threat. When a Republican lawmaker revived an expansion proposal last week, Kasich was quick to throw his support behind the plan.
“We’re making progress, and it’s encouraging to see,” his spokesman Rob Nichols told the Columbus Dispatch. “There’s an appreciation for what’s at stake—Ohio’s continued economic recovery and the health of vulnerable Ohioans—that has been able to move the process forward. There can be many routes to the same place, and as long we get this done, the governor doesn’t care who gets the credit.”