Gov. Rick Scott's 'new perspective': expand Medicaid after all

TALLAHASSEE — Gov. Rick Scott said Wednesday he supports expanding Medicaid and funneling billions of federal dollars to Florida, a significant policy reversal that could bring health care coverage to 1 million additional Floridians.

"While the federal government is committed to pay 100 percent of the cost, I cannot, in good conscience, deny Floridians the needed access to health care," Scott said at a hastily called news conference at the Governor's Mansion.

Scott, a former hospital executive, spoke with unusual directness about helping the "poorest and weakest" Floridians — a stunning about-face for a small-government Republican who was one of the loudest voices in an aggressive, and ultimately unsuccessful, legal strategy to kill a law he derided as "Obamacare."

Throughout his 2010 campaign for governor, as Scott sought support from tea party members, he called the law a "job killer" that would hurt Florida.

On Wednesday, he called the proposed Medicaid expansion, at least for an initial period, "common sense."

Tea party activists bitterly criticized Scott's declaration.

"This is just another example of Republicans lying to Floridians," said Everett Wilkinson of Palm Beach Gardens, calling Scott "the Benedict Arnold to the patriot and tea party movement in Florida."

Scott was careful to point out that the Republican-controlled Florida Legislature will ultimately decide whether or not his proposal is worth implementing. That is far from certain, particularly in the more partisan House.

"Gov. Scott has made his decision, and I certainly respect his thoughts," said House Speaker Will Weatherford, R-Wesley Chapel. "However, the Florida Legislature will make the ultimate decision. I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability."

"I respect the governor for staking out a clear position," added Sen. Joe Negron, R-Stuart, who chairs a Senate committee studying the health care law. He said senators would reach their own conclusions likely in early March.

Scott said he would support an initial three-year expansion of Medicaid but made clear he would not twist legislators' arms to make it happen. He reiterated that his top priorities are a $2,500 pay raise for teachers and a sales tax break for manufacturers' equipment purchases.

Under the governor's proposal, after three years the Legislature would have to vote to reauthorize the program to keep it going.

"It is not a white flag of surrender to government-run health care," he said, as if anticipating a political backlash from his most conservative supporters.

Part of his self-described "new perspective" came from the death of his mother, Esther, last year, he said.

"A few months ago, my mother passed away, and I lost one of the only constants in my life," Scott said. "Losing someone so close to you puts everything in new perspective . . . especially the big decisions."

For weeks, Scott has said the debate on expanding Medicaid was directly tied to the state's application for waivers it needs to allow private companies to run the program.

His endorsement of the expansion came hours after the federal government agreed to grant Florida a conditional waiver to privatize Medicaid statewide for the state's more than 3 million current recipients, more than half of which are children or people under age 21.

Scott and GOP lawmakers have repeatedly warned that Medicaid's roughly $21 billion annual costs were consuming Florida's budget and proposed the managed care plan to save money and improve care.

The privatization expands on a five-county pilot program that has been rife with problems. Critics worry for-profit providers are scrimping on patient care and denying medical services to increase profits. Some doctors have dropped out of the pilot program, complaining of red tape and that the insurers deny the tests and medicine they prescribe. Patients have complained they struggled to get doctor's appointments.

Several health plans also dropped out of the pilot program, saying they couldn't make enough money. Patients complained they were bounced from plan to plan with lapses in care. Nearly half of the 200,000 patients enrolled in the pilot have been dropped from at least one plan, federal health officials noted at one point during negotiations.

Lawmakers say they have fixed the pilot program's shortcomings, with provisions including increased oversight and more stringent penalties, including fining providers up to $500,000 if they drop out. The measures also increase doctors' reimbursement rates and limit malpractice lawsuits for Medicaid patients in hopes of increasing doctor participation in the program.

Medicaid, a joint state-federal, government-run health care program, is voluntary for states. But every state participates, in part because of the good financial terms. The federal government covers about 55 percent of all Medicaid costs in Florida and covered about 68 percent in recent years with additional stimulus funding.

The health care law tried to entice states to expand eligibility to Medicaid by raising income eligibility limits. To do so, the federal government agreed to fund 100 percent of the cost for states to expand Medicaid for three budget years. The federal government would then cover 95 percent of the costs in 2017, 94 percent of the costs in 2018, 93 percent of the costs in 2019 and 90 percent of the costs in 2020 and beyond.

Recent polls conducted by the American Cancer Society's Cancer Action Network and the Florida Hospital Association indicated that most Floridians supported the Medicaid expansion.

Scott said Wednesday that he had to look past his long-standing opposition to the health care law to reach his decision.

"It doesn't matter what I believe. It doesn't matter what anybody believes," Scott said. "The Supreme Court's already made their decision. We had an election in the fall, and the public made their decision."

Information from the Associated Press was used in this report.

The story

. Federal government conditionally approves Florida plan to privatize Medicaid system.

. Hours later, Scott endorses plan to expand Medicaid eligibility.

. Top GOP lawmakers, who must sign off, remain noncommittal.

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The story

. Federal government conditionally approves Florida plan to privatize Medicaid system

. Hours later, Scott endorses plan to expand Medicaid eligibility

. Top GOP lawmakers, who must sign off on expansion, remain non-committal

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