By John Kennedy
Florida Gov. Rick Scott said Wednesday he wants to expand the state's Medicaid program to add 1 million lower-income patients to the rolls, endorsing a key provision of President Barack Obama's federal health care overhaul that the Republican governor fought for years.
Scott announced his change of heart only hours after the Obama administration said it was close to finalizing approval of the state's plan to revamp Medicaid by putting most of Florida's 3.5 million patients into managed care plans.
Florida officials have forecast big cost savings from moving patients into HMOs and other managed care services. State and federal officials have been negotiating for two years over the proposal.
Scott refused to say directly that his push for expansion stemmed from federal action on the managed care waiver. But Wednesday's developments did lead Scott to make a distinctly personal appeal in urging that the Republican-ruled Florida Legislature move ahead with Medicaid expansion.
Scott reflected on the death of his mother, Esther, last fall. He recalled her struggle to raise five children with little money, and a constant worry of having health coverage for the family.
The multi-millionaire governor, who made his fortune as a health care executive, said no Floridians should endure the challenges his mother faced.
"No mother or father should despair over whether or not they can afford -- or access -- the health care their child needs," Scott said in a brief news conference Wednesday evening at the Governor's Mansion.
Scott faces re-election next year and continues to draw poor approval ratings from Floridians in most polls. A recent poll showed more voters would support former Republican Gov. Charlie Crist, now a Democrat, over Scott next year.
But Wednesday, Scott sounded a populist theme in calling for a three-year trial expansion, a period that would allow leaders to gauge whether Medicaid expansion is effective.
"Quality health care services must be accessible and affordable for all -- not just those in certain zip codes or tax brackets," Scott said.
Florida CHAIN, a health advocacy organization frequently critical of Scott, said, "The governor's decision is the right one for Floridians and the only viable option for Florida." Scott, though, could be in for a struggle.
The governor's first two years in office were marked by battles with outnumbered Democrats over tax breaks and budget cuts. But Scott's endorsement of Medicaid expansion immediately put him at odds with many GOP members, particularly in the House.
House Speaker Will Weatherford, R-Wesley Chapel, was quick to tap the brakes.
"The Florida Legislature will make the ultimate decision," Weatherford said, in a statement sent minutes before Scott even made his announcement. "I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability." Scott's move brought even harsher condemnation from tea party supporters.
"I have never been more disappointed in Governor Scott," said Tarren Bragdon, president of the Foundation for Government Accountability, a conservative think tank, which has provided analysis that supported Scott on a host of other policy initiatives.
"Adding another million Floridians to the welfare rolls with borrowed money from Washington is exactly the wrong way to get Florida working. Fortunately, the real leadership on this issue has always been in the Legislature," Bragdon said.
Slade O'Brien, state director of the Americans For Prosperity, whose founders included the conservative Koch brothers, also blasted Scott.
"At every level of government, it is too easy for politicians to spend other people's money," O'Brien said. "For far too long, states have fallen for the promises of 'free' federal money, ignoring the insidious federal strings and the long-term effects on state budgets."
Scott, though, nuanced his support for Medicaid expansion. He said he is endorsing the approach only for the three years in which the federal government will fully finance costs of those added to the rolls.
After that, Scott said the program would be re-evaluated.
"Three years is a reasonable period to judge just how well the expansion is working and to explore further reforms to improve cost, quality and access in health care -- both in the public and private markets," Scott said.
Scott also insisted he was not retreating from his earlier views of the federal health law. Scott's first foray into politics came when he formed a political committee, Conservatives for Patients Rights, to oppose the health care plan as it made its way through Congress.
"It is not the end of our work to improve health care," Scott said. "And it is not a white flag of surrender to government-run health care."
Under the expansion, the federal government would pay for 100 percent of the expansion until 2016, when states would start paying a 5 percent share that would gradually increase to a maximum of 10 percent of new costs by 2020.
Estimates vary, but analysts have said Medicaid expansion could bring Florida $26 billion in federal dollars over the next decade. Florida taxpayers are expected to pay $3 billion during that period, according to the state's Agency for Health Care Administration. The overhaul would eliminate a maze of categories that currently determine eligibility.
Instead, starting in January 2014, benefits would be offered to anyone whose household income is 138 percent of the federal poverty level or less. That means those with annual incomes of roughly $15,000 for individuals and $29,000 for a family of four, officials said.
The program also would be opened for the first time to non-disabled adults without dependent children -- a population that Florida officials warn could prove costly. Health care leaders, however, say that if more uninsured Floridians were covered by Medicaid, fewer would use emergency rooms, saving money. Florida has almost 4 million uninsured residents.
On the managed care waiver, the federal Centers for Medicare and Medicaid told the state it had reached agreement in principle on Florida's plan but still wants some conditions met.
Among the conditions: that the state hire an independent authority to monitor the move to managed care and have a plan to measure the quality of patient care. These standards are needed to resolve problems in a pilot program in place since 2006 in Broward County, Duval County and three of its neighboring counties, officials said.
Federal officials have already approved a plan to move Florida elderly and other long-term Medicaid patients into managed care beginning later this year. The broader expansion of the program would begin next year and be fully in place by 2015, officials have said.
(c)2013 The Palm Beach Post (West Palm Beach, Fla.)