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Politics

Rick Scott Doesn't Favor Medicaid Expansion

April 6, 2015 - 6:00pm

Adding more drama to a $5 billion budget standoff between Republican legislative leaders, Gov. Rick Scott on Monday reversed course on his one-time support for providing health coverage for low-income Floridians as part of the federal health-care law known as Obamacare.

Scott blamed his rejection of a state Senate plan on a distrust of the federal government, the result of an apparent breakdown in negotiations between his administration and federal officials over a program that pays hospitals and health providers for unreimbursed care. The feds contribute at least $1.3 billion a year toward the Low Income Pool, or LIP, program.

The U.S. Centers for Medicare and Medicaid Services last year gave the state a one-year extension on LIP -- set to expire on June 30 unless Scott and federal officials reach a new agreement -- but the Obama administration is unwilling to renew the program in its current form.

The Senate and Scott included $2.2 billion to cover the costs of LIP in their budget plans, but Republican House leaders did not.

To sweeten the deal for the feds, the Senate linked the revised LIP program with another $2.8 billion for the "Florida Health Insurance Affordability Exchange," or FHIX, to pay insurance premiums for about 800,000 Floridians with incomes up to 133 percent of the poverty level. Under the Affordable Care Act, the federal government would pay the state about $47 billion over the next eight years for the program. That money would come from a pot that is earmarked for Medicaid expansion across the country, though Senate officials have tried to distance their proposal from the Medicaid program.

The House has balked outright at a Medicaid expansion -- or anything that looks like a Medicaid expansion -- and on Monday Scott joined the chorus of Republican naysayers.

" Given that the federal government said they would not fund the federal LIP program to the level it is funded today, it would be hard to understand how the state could take on even more federal programs that CMS could scale back or walk away from," Scott said in a statement.

As a candidate seeking re-election to a second term, Scott gave tepid support in 2013 to a similar Senate plan but failed to campaign for the doomed proposal's passage.

"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, who made his fortune in the hospital industry, told reporters in February 2013.

It may not come as a surprise that Scott, who ran as a tea party "outsider" in 2010, has shifted his position on Medicaid expansion. The conservative Americans for Prosperity has targeted Republican senators, including Senate President Andy Gardiner, for supporting the issue, part of what was once considered a cornerstone of the Affordable Care Act but which the U.S. Supreme Court left up to the states in a seminal ruling upholding the federal law.

Scott's turnaround didn't persuade Gardiner to back down from his chamber's proposed fix for hospitals and low-income, uninsured Floridians.

In a statement issued Monday in response to Scott, Gardiner made a veiled threat about Scott's push for record-high public school funding and nearly $675 million in tax cuts.

"The Senate also shares the governor's commitment to tax relief and record funding for education; however, if our state is forced to make up the difference of $2.2 billion in hospital funding, every area of our budget will be impacted," Gardiner, R-Orlando, said. Moving forward the Senate will continue to advance the conservative, Florida-based, free-market solutions we have proposed. We believe these innovative, bipartisan proposals can gain the approval of our federal partners, and we stand ready to meet with the House or Governor Scott at any time to discuss a way forward.

Without telling Scott, Gardiner last week dispatched two senators to meet with federal health officials to discuss the Senate's plans. The next day, Scott's office announced that the Obama administration official in charge of negotiations had abruptly ended the talks. It was later learned that the lead federal negotiator, Eliot Fishman, had left the country for a long-planned trip to Israel.

Senate budget chief Tom Lee, who met with Scott and his top aides late last week, said Monday that the governor made it clear "he was no big fan of dealing with the uninsured in Florida."

Lee likened the Legislature's position to being in a "box canyon," another term for a three-sided, deep ravine with only one way in or out.

"Behind us, we have the Centers for Medicare and Medicaid Services telling us that we don't have a budget solution on the one hand. And we have the governor saying you can't fix this problem using general revenue. And on the other hand, we've got people saying they're re not going to talk about insuring low-income Floridians, which is part of the problem here. We have too many Floridians creating this unreimbursed care. So we're very much in a box canyon right now," Lee, R-Brandon, said.

A fiery speech last week by Lee's House budget counterpart Richard Corcoran, slated to take over as House speaker after the 2016 elections, deepened the divide between the two chambers over the coverage expansion.

"We're not dancing this session, we're not dancing next session, we're not dancing this summer," Corcoran, R-Land O'Lakes, said before a House vote on the budget Thursday

The showdown between the two chambers, coupled with the breakdown in talks between the Scott administration and federal officials over LIP, heightens uncertainty about whether lawmakers will finalize budget negotiations before the scheduled May 1 end of the legislative session.

Politically, the House has more to lose than the Senate by caving on the Medicaid-expansion issue, said GOP strategist J.M. "Mac" Stipanovich.

"There's only one person here who has to prevail in his position, and that's Rep. Corcoran. Can President Gardiner not exert himself? Can he not lay waste to all the priorities of the House? Can he not show the Senate's strength and its outrage? Of course he can. He doesn't have to win on Medicaid. He has to be strong and purposeful and he has to punish what is a pretty flagrant breach of protocol. But he doesn't have to win on Medicaid," Stipanovich said.

Meanwhile, House Republicans -- and Scott -- are relying on the Obama administration to come up with the LIP money left out of the House spending plan.

"In an ironic way, the perception of victory for the conservatives probably lies in the hands of their arch-enemies in Washington," Stipanovich said.

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