No politician made more of a name for himself opposing President Obama’s federal healthcare overhaul than Florida Gov. Rick Scott. Scott, a former healthcare executive, provided the seed money for a multimillion dollar anti-Obamacare ad campaign under the umbrella of Conservatives for Patients’ Rights.
“I want healthcare reform to happen but I want it the right way,” Scott said at the time. His advertising blitz didn’t derail or substantially alter the Affordable Care Act, but it did raise his profile. On the strength of his new notoriety, Scott ran for governor and beat the more established Florida Republican Bill McCollum, the state attorney general and former congressman, in the primary, on his way to victory in November.
As governor, Scott led Florida in a 26-state lawsuit that challenged the constitutionality of both Obamacare’s individual mandate and its requirement that states expand eligibility for Medicaid, a joint federal and state healthcare program for the poor.
Everyone remembers how the case against the individual mandate turned out, but Scott and company actually won a partial victory on the Medicaid expansion. The Supreme Court ruled that states could not have federal matching funds revoked if they refused, thereby giving them a real choice to opt out.
“We’re not going to implement Obamacare in Florida,” Scott blustered. “We’re not going to expand Medicaid, because we’re going to do the right thing.”
Yet look who’s taking the new Medicaid funds. Scott announced last week that Florida would participate after all, saying, “While the federal government is committed to paying 100 percent of the cost of new people to Medicaid, I cannot, in good conscience, deny the uninsured access to care.”
To conservatives who see this as “a white flag of surrender to government-run healthcare”—his words, not mine—Scott has three responses. The first is that he will be allowed to continue his state Medicaid reforms, which his supporters argue amount to a partial privatization, courtesy of an Obama administration waiver.
Secondly, Scott contends that his decision is contingent on the federal government picking up the full tab. He has suggested a sunset provision after three years, when Washington goes from paying for 100 percent of the Medicaid expansion to as little as 90 percent. But it is highly unlikely that enrollees under the new eligibility standards would be turned away after that three-year period, and Scott admitted as much: “I want to be clear that we will not simply deny new Medicaid recipients health insurance three years from now.”
Finally, Scott in effect claims that this move is necessary to make sure Florida gets its fair share of federal funds. But Scott’s decision will by definition cost federal taxpayers billions while penalizing states that don’t go along—thus increasing the likelihood that more states sign on to this component of Obamacare.
Scott isn’t alone. Six other Republican governors have gone along with Obamacare’s Medicaid expansion, even though five of them run states that participated in the litigation against it. Arizona’s Jan Brewer, a frequent Obama sparring partner, and Ohio’s John Kasich, who held Paul Ryan’s job on Capitol Hill in the 1990s, are among those taking the money.
Expanding Medicaid will come at an enormous cost to federal taxpayers, with the Congressional Budget Office estimating a $643 billion price tag for adding 11 million people to the program. It will ultimately grow state governments as well, as the cash-strapped feds eventually renege on their funding promises and begin to shift the additional Medicaid costs to the states. And it will help entrench Obamacare as the law of the land, making states supplicants rather than sources of resistance.
All this as the program is increasingly associated with fraud and bad healthcare outcomes for its beneficiaries—largely because Medicaid payments often don’t cover the costs of treating patients, causing fewer physicians to take them.
The Florida legislature may still override Scott and at least 13 Republicans governors have refused to sign on to the Medicaid expansion. But it’s beginning to look like that sad, familiar tale of Republicans beating their chests against Obamacare and other attempts to grow government, only to take the lead in acclimating the party to the federal trough.
W. James Antle III is editor of the Daily Caller News Foundation and author of the forthcoming book Devouring Freedom: Can Big Government Ever Be Stopped?