Scott, Crist split on Medicaid expansion

TALLAHASSEE — As he gains momentum in the race for governor, Charlie Crist is driving a conversation on Medicaid expansion.

The Republican-turned-Democrat has become such a fervent supporter of the policy that he said he would consider using an executive order to get it done.

"A million Floridians are not getting the health care they need because of Rick Scott's lack of effort," Crist told the Tampa Bay Times/Miami Herald. "Florida deserves to have a governor who understands that this is affecting people's lives."

Republican Gov. Rick Scott — who went from opposing Medicaid expansion to supporting it, albeit without ever really lobbying for it — hasn't talked about the issue on the campaign trail.

But Scott said he was not surprised Crist would consider an executive order, drawing a comparison to the president.

"That is what President Obama does — refuses to work with legislators and just goes his own way and issues decrees," he said in a statement.

The issue may be key in the final weeks of the campaign.

"This could help Crist drive Democrats to the polls," Barry University political science professor Sean Foreman said, noting Crist's strategy relies on voter turnout in left-leaning counties like Broward and Palm Beach.

Most polls consider the race a tie. But some have Crist pulling slightly ahead — a notable change from past weeks when the better-funded Scott had the advantage.

Medicaid expansion has been a contentious issue since it was first announced as part of the federal Affordable Care Act.

Florida Democrats and some Senate Republicans have said the state ought to accept $51 billion in federal money to expand the program, which provides health insurance for the poor. Most of the state's business associations and health care providers agree.

"It is in our interest to see this happen because we've seen countless problems with patients who show up in our facility, many of whom work, but don't have insurance," said Steve Mason, who heads the nonprofit BayCare Health System, Tampa Bay's largest provider.

But the conservative Florida House has blocked Medicaid expansion the past two years. Some Republican representatives are philosophically opposed to accepting the federal funds. Others have argued that Florida ought to come up with a better plan. An estimated 800,000 to 1 million Floridians remain uncovered by insurance.

Scott initially opposed expansion. When he changed his mind in 2013, it made headlines across the country.

In a statement, Scott clarified his position.

"I said that I would only agree to expand Medicaid if it did not cost Florida taxpayers," he said. "It would be wrong to make promises to provide care that the state could ultimately not afford or sustain."

Foreman called Medicaid expansion a "sticky issue" for the incumbent.

"It doesn't do him any good to support Medicaid expansion as a campaign issue," he said. "His party is against it. The Legislature refused to move it last year."

Despite his willingness to take the money, Scott firmly opposes the federal health care law.

Crist, meanwhile, says if elected he would rather work with the Legislature to expand Medicaid. He said it may be possible win support in the House after Speaker Will Weatherford's term ends this year.

"He was the main impediment," Crist said. "Some of the other personalities will change as well."

Crist said he had not discussed the issue with incoming House Speaker Steve Crisafulli, R-Merritt Island. In a statement, Crisafulli called Obamacare "a disaster" and noted Florida wasn't alone in refusing expansion.

Even without House support, Crist says there could be an alternative. He pointed to Ohio Gov. John Kasich, who signed an executive order expanding Medicaid in his state last year.

Kasich circumvented the Ohio Legislature with the help of an obscure legislative panel known as the controlling board. Florida has no such entity.

"An expansion of Medicaid could not be accomplished on a whim from the executive office," Scott said in the statement. "It requires legislative action."

Crisafulli also doubts such a move would be legal.

Most of the business groups that support Medicaid expansion have held strong in their support for the pro-business Scott.

But Crist's position on Medicaid expansion — and the potential for an executive order — will likely resonate with voters.

A recent poll from the Democratic-leaning survey firm Public Policy Polling found that 61 percent of voters favor Florida taking the federal money.

The support is even more pronounced among Hispanic voters. Two-thirds of Hispanic voters surveyed this month by Latino Decisions, a leading Latino political opinion research firm, said they would be more likely to vote for a candidate who supports Medicaid expansion.

Autar Kaw, an independent voter and mechanical engineering professor at the University of South Florida, said the issue helped him choose a candidate.

"I was disappointed that Gov. Scott didn't push for the Medicaid expansion," said Kaw, who cast an absentee ballot for Crist.

Juan Galán, a Republican from Coral Gables, said he was "leaning heavily toward Crist."

"It's important," the retired investor said. "We need to have a way to help people who unfortunately can't help themselves."

But John Kubik, a 65-year-old contractor from Casselberry, said his top priority was electing a governor who opposes the federal health care law.

"I don't think that it is good for the country," he said, pledging his support for Scott.

Contact Kathleen McGrory at kmcgrory@miamiherald.com. This article includes comments from the Public Insight Network, an online community of people who have agreed to share their opinions with the Miami Herald and WLRN.