Leadership matters. In Arizona, Republican Gov. Jan Brewer set aside her opposition to health care reform, called the legislature into special session and forced it to approve Medicaid expansion. In Florida, Republican Gov. Rick Scott had a similar epiphany but hardly lobbied Republican lawmakers who refused to expand Medicaid. Now that he has signed into law or vetoed most legislation, Scott should refocus on the most important issue facing Florida and demand action.There are moral and medical arguments for expanding Medicaid in Florida. It would cover nearly a million uninsured adults earning $15,856 or less and create a healthier state. But that is not persuasive to House Speaker Will Weatherford, R-Wesley Chapel, who believes poor people could get health coverage if they just worked harder and got better jobs that offered insurance. So Scott and the business community should hammer home the hard-nosed, economic reasons Florida should expand Medicaid:Job creationFlorida would receive $51 billion in federal money over 10 years, and the cost of the expansion would be entirely covered with federal dollars for the first three years. After that, federal money would cover at least 90 percent of the cost.Families USA calculates that more than 70,000 new jobs would result from Medicaid expansion. Hiring would increase in the state's health care sector. Newly insured patients would increase demand for services from doctors, nurses and pharmacists. That would boost activity in construction and other trades.Economic competitivenessWithout Medicaid expansion, two business-backed health insurance coalitions said last week businesses will leave the state for more economical health insurance markets.Health insurance costs for large employers will be less in states with Medicaid expansion, the coalitions said. Doctors and hospitals won't be shifting costs for providing charity care onto insured businesses and consumers. Expanding Medicaid will be a more effective business recruitment strategy than the governor's classless letters trashing other states and begging businesses to move here.Business penaltiesFlorida employers with 50 or more full-time workers will face added penalties unless Medicaid is expanded.Employers who don't offer health coverage will pay a penalty of $2,000 for every employee, minus the first 30. If companies offer coverage but it's too expensive, they can face other penalties. An estimated 400,000 Floridians earn from $11,490 to $15,856 a year. They would qualify for Medicaid expansion, but they are eligible to purchase insurance on online exchanges if Medicaid is not expanded. Tax services firm Jackson Hewitt estimates that for these workers who go to the health care exchanges, the cost in penalties to Florida employers is $147.5 million a year.Rejecting Medicaid expansion is a self-inflicted wound. Scott still has an opportunity to make the economic case for Florida businesses and demand that the Legislature take action, just as Brewer did in Arizona.