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On Medicaid, take the money and fund

You have to give it up to Gov. Rick Scott for coming around on Medicaid expansion. I never thought it would happen. Yet now Scott is one of eight Republican governors to announce their intention to support it, with Gov. Chris Christie of New Jersey being the latest. How refreshing to see such fierce opposition give way to reasoned acceptance. These politicians know a good deal even if their tea party base doesn't.

But Scott may be the biggest shocker. He burst on to the political scene as an opponent of the Affordable Care Act, sinking $5 million of his own money into an effort to kill it. As governor he refused to implement the law, turning back millions of federal dollars.

Even so, Scott has recognized there comes a point when the fighting has to stop and governing begin. The presidential election is over, the U.S. Supreme Court refused Florida's demand that the law be set aside (although the court did give states the discretion to decide whether to expand Medicaid, which is why we're having this debate), and, for good measure, Florida voters defeated an anti-Affordable Care Act constitutional amendment in the last election.

Floridians want health care security, something that every other citizen of an advanced nation has. Maybe the Affordable Care Act isn't the perfect approach, but it's a major step forward and will bring Americans peace of mind to know that a job loss won't leave them without health insurance. That's why the law is politically popular in the state. The latest polls show roughly 62 percent approval.

In announcing his change of heart, Scott said he cannot "in good conscience" deny Floridians access to health care as long as the federal government pays 100 percent of the cost, which it will for the first three years.

Conscience is an apt word for Scott's decision. One's conscience serves as guide, pointing to what is good, right, compassionate, honorable and humane. Providing Medicaid to roughly 1 million additional Floridians is all those things, and it's also an incredibly good deal that the state's leaders should not pass up.

Under the program, the federal government picks up 100 percent of the cost of expanded Medicaid coverage for the first three years, from 2014 through 2016, for families that make up to 138 percent of the federal poverty line. After that, the federal share declines only slightly until it hits 90 percent in 2022 and beyond.

This will increase health care spending in the state by an estimated $4.9 billion in 2016 alone, according to projections from the nonprofit Families USA. Those new federal dollars will pump up the health care system through direct payments to hospitals, doctors and pharmacists.

When so much new money is injected into a state economy there's a multiplier effect, such as when a hospital expands, buys supplies and employs construction workers. Taking that into account, the Families USA report calculates an estimated 71,300 new jobs will be supported across all sectors of the Florida economy. The resulting boost in economic activity is projected to be $8.9 billion in 2016 alone.

One can quibble with the numbers — other studies have found lower yet still substantial economic benefits — but the debate is not furthered when Agriculture Commissioner Adam Putnam tweets that Medicaid expansion "does not create jobs," then can't back up his claim with solid evidence. Or when Attorney General Pam Bondi breathlessly announces that expansion is a "surrender" of control over health care to the federal government. Does she think an uninsured working mother who can't afford to see a doctor when she's sick cares about that philosophical debate? Is Medicare a surrender, too?

On the other side of the ledger, the out-of-pocket costs to the state to extend Medicaid are minimal, estimated at $3 billion over the next decade. Firmer numbers by the state's legislative economists are expected soon.

What is undeniable is if the state fails to extend Medicaid, Florida's safety net hospitals are set to lose huge sums, since the law presumed that the newly insured would make up for cuts in other payments.

Here are the tough numbers: The Affordable Care Act reduces the growth of Medicare by about $700 billion by 2022. Since Florida makes up 8.3 percent of total Medicare spending in the country, it faces a potential loss of $58 billion. That comes on top of deep cuts in funding known as Disproportionate Share Hospital payments, dollars that flow to hospitals that do a lot of charity care. Florida's current annual allotment is about $200 million.

Add it all up and Scott's decision to support Medicaid expansion makes sense from every angle but one — the one that puts tea party purity over what's best for people and the economy. Florida's Republican legislative leaders should consider this in deciding where their responsibilities lie.

On Medicaid, take the money and fund 03/01/13 [Last modified: Friday, March 1, 2013 5:19pm]

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