Whatever Florida Gov. Rick Scott and Attorney General Pam Bondi's personal disappointment with the U.S. Supreme Court's decision largely upholding the Affordable Care Act, they have an obligation to carry out the law's terms and stop claiming its constitutionality is suspect. "Obamacare," as they derisively call it, won the day before the nation's highest court last week. It is constitutional. Responsible leaders, instead of grandstanding on national television, would graciously accept the loss and get to work for Florida's 4 million uninsured residents.
Scott has done little since becoming governor to address the more than one in five Floridians who are without health insurance. Instead he has positioned himself as one of the chief antagonists of the health care reforms of President Barack Obama. Friday night he told Fox News anchor Greta Van Susteren that he would not implement the law in Florida, much like other Republican governors have said. A former CEO of a chain of hospitals, Scott thinks unfettered free market competition is the way to solve the health care crisis. But the free market system is what has led the nation to spend more than any country in the world with far inferior health outcomes and 50 million people uninsured.
Bondi, who helped lead the 26-state challenge to the law, appears to have forgotten basic constitutional law established in Marbury vs. Madison when the Supreme Court established itself as the final arbiter of what is constitutional. After the health care ruling, she told Sean Hannity on Fox News, "We still firmly believe it's unconstitutional," referring to the law.
The ACA will give Americans access to affordable private health insurance, regardless of a pre-existing condition or job loss, beginning in 2014. Consumers who don't receive health insurance through an employer or the government will be able to obtain it through an online state insurance exchange, often with federal subsidies. But Scott has flatly rejected millions of federal dollars to prepare any exchange and now plans to stand by idly while other states build theirs. Scott's actions — or inactions — mean the federal government will have to create a health insurance exchange for the state.
Scott is also intent on rejecting the expansion of Medicaid that would serve more than 1 million additional poor Floridians. The Supreme Court said states can choose whether to opt in to the Medicaid expansion. But Florida has a moral and fiscal responsibility to do so.
While the state's health insurance programs for the poor cover most children in poverty, the expansion would provide coverage to adults making up to 133 percent of the federal poverty line, or $25,390 for a family of three. These are the people who are most likely to be uninsured and use expensive visits to the hospital emergency rooms for health care. Under the ACA, the federal government will pick up 100 percent of the cost of Medicaid expansion over the first few years, with the federal responsibility slowly falling to 90 percent.
Scott told Fox News that he is rejecting this money because he thinks eventually Florida will be on the hook for 45 percent of the cost. But there is no basis for this belief. What is true is that Scott's stance ensures that Florida taxpayers will help foot the bill for the poor to be cared for in other states while also subsidizing the cost of uncompensated care at Florida hospitals.
The ACA is the law of the land and should be respected as such in the interest of Florida and its people. Scott and Bondi have a job to do, and it's not guest-starring on cable news networks.