WASHINGTON — Florida Gov. Rick Scott said Monday that he had a "great conversation" with the Obama administration's health secretary, continuing to project openness toward a health care law he once fiercely opposed and used as a springboard to political office.
But Scott emerged from the meeting with Health and Human Services Secretary Kathleen Sebelius with the same concern about the cost of expanding Medicaid and resistance to partnering with the federal government on a health care exchange, for which the state has already missed a December deadline.
"I want the right health care safety net for our citizens, but whatever we do, it's got to be a program that works for Florida," the governor told reporters. "We cannot have an adverse impact on access to quality health care or the cost of health care."
The noncommittal approach reflects tense undercurrents, with health care advocates pointing to the U.S. Supreme Court decision upholding the law and President Barack Obama's re-election as a mandate to move forward and with Scott's political base not trusting government claims of lower costs.
Tea party members spent the past few days emailing and calling Scott to warn him against working closely with the federal government. "He would be the ultimate hypocrite," said Everett Wilkinson, a group leader in South Florida. "One of the main reasons he ran for governor was to oppose Obamacare."
Scott faces re-election in two years and has moderated his stance on several issues, including health care, saying he was ready to negotiate. Still, he seemed no more open to changes Monday than he did immediately after the November election.
He remains chiefly worried about an expansion of Medicaid, a cornerstone of the health care law, which seeks to lower costs by covering the uninsured. The U.S. Supreme Court, while upholding the bulk of the law, said states can opt out of the Medicaid expansion.
Scott said nearly doubling the number of Medicaid participants (currently 3.3 million in Florida) would cost $63 billion over 10 years, with Florida's taxpayers contributing about $26 billion. That figure is at sharp odds with the $8 billion state liability economists projected in August. Critics say Scott is playing with numbers to support his opposition.
In the meeting, Sebelius reminded Scott that Florida has the nation's third-highest rate of uninsured and that the federal government would pay 100 percent of the costs of Medicaid expansion for the first three years, then 90 percent after that.
Sebelius urged him to work with the government on a health insurance marketplace and said there were other programs the state could adopt to lower costs. "She also reiterated her commitment to flexibility as HHS works with states to continue implementing the Affordable Care Act," Sebelius' office said in a statement.
"I'm worried not about the next three years but the next six, seven years," Scott told reporters, repeating his mantra that more government does not come free.
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"Unfortunately, since Gov. Scott took office, our state has developed a reputation for sending federal dollars back to Washington," said U.S. Rep. Kathy Castor, D-Tampa, one of several Democrats unhappy with Scott's reluctant stance. "We need these federal dollars right here in the state of Florida, helping Floridians. Floridians with health insurance subsidize health care for those who do not have health insurance."
Jim Zingale, an official with the Safety Net Hospital Alliance of Florida, echoed that sentiment and said the billions in federal spending would bring jobs: "This is going to be one of the largest economic booms in the state."
U.S. Rep. Rich Nugent, R-Spring Hill, sent a letter to Sebelius that read, "The fact of the matter is that if Governor Scott agrees to the Medicaid expansion, he will be committing the State of Florida to writing a blank check. We don't know whether it will be $8 billion, $26 billion, or some other untold amount. And the American people at large will be expected to pay to pick up the federal government's portion of the yet-to-be-determined tab."
Henry Kelley, with the Florida Tea Party Network, said Scott's talks in Washington are worthy of praise and concern. "I'm fine with him trying to work out things on Medicaid. It's an enormous (budget) line item and if there's a smarter way to do it, it at least needs to be pursued." But he said Scott should let the federal government design a health care exchange for Florida. "The Democrats in Washington passed this. Let them own it."
Scott used the meeting to press Sebelius to grant the state a waiver to put more Medicaid recipients into private managed-care programs. He said he hoped talks would continue.
Always a pitchman for the state, Scott began his news conference by saying that reporters would not need to wear jackets if in Florida. He ended with, "Thanks. Have a great day. Move to Florida."