This is a tale of two Republican governors who oppose the Affordable Care Act. One looks out for the best interests of his state's residents, and one does not. One is pragmatic about accepting federal money to cover the uninsured, and one is hypocritical. Guess which one is Ohio Gov. John Kasich and which one is Florida Gov. Rick Scott.
Hint: Both governors live in states with highly ranked college football teams, but the pragmatic one lives where it snows.
Kasich took extraordinary measures this week to win legislative approval to accept more than $2.5 billion in federal dollars in the next fiscal year to expand Medicaid and cover 275,000 uninsured Ohioans. That makes Ohio the 25th state to move toward accepting Medicaid expansion money, including a number of states with Republican governors. Yet Florida sits on the sidelines because of a weak governor and a stubborn state House speaker who places ideology above the health of the state's residents.
Florida would receive $51 billion in federal money over 10 years to cover 1 million uninsured residents if the Legislature would vote to accept the Medicaid expansion money under the Affordable Care Act. Federal money would cover the entire cost of the expansion for the first three years, and then the state would gradually pick up part of the cost until it paid 10 percent. Now low-income Floridians who would be covered by the expansion fall into a gap: They don't qualify for Medicaid, and they make too little money to qualify for subsidies to buy insurance in the new federal marketplace. So they will continue to show up in hospital emergency rooms for expensive charity care, and the costs are paid by taxpayers at public hospitals and by paying patients through higher insurance premiums. Scott said Florida should take the Medicaid expansion money, but unlike Kasich, he hasn't lifted a finger to force the issue.
One of House Speaker Will Weatherford's specious arguments against accepting the Medicaid expansion money is that the federal government can't be trusted to pay its share and could force the state to pay more. Yet the Scott administration wants the federal government to contribute another $2 billion a year to a different program that helps cover health care costs for the poor and uninsured. So it's fine to seek federal money and use it to pay for health care costs for poor Floridians — as long as the money is not tied to President Barack Obama's signature health care reform. That's the kind of pretzel logic that only makes sense in Tallahassee.
In Ohio, the governor's office says on its website that if the state did not accept the Medicaid expansion money, the federal money and the jobs it will create would go to other states. That is exactly what Florida is doing by giving up billions in federal dollars and the thousands of jobs it would help create to provide health care to residents who need it.
There is a smarter approach. Scott should prod the Legislature to accept the federal Medicaid expansion money, and Florida does not even have to spend it on Medicaid. It could use the Arkansas model, which uses the money to subsidize the cost of private insurance for the uninsured. Until then, uninsured Floridians who don't qualify for Medicaid but earn too little income to qualify for insurance subsidies have a last resort:
Buy a snow shovel and move to Ohio, where the Republican governor and legislative leaders are more compassionate and economically pragmatic than their Florida counterparts.