Gov. Rick Scott reversed course Monday, saying he no longer supports Medicaid expansion as talks break down between Florida and its request for the federal government to extend funds to hospitals that serve low-income patients.
Scott wants the federal Centers for Medicare and Medicaid Services to give Florida about $1 billion in hospital funds, but federal officials have been denying that request for about a year, standing firm that the funds will end June 30. Negotiations between state and federal health officials turned ugly in the past week, with the state accusing federal officials of walking away from discussions and sending a series of frenzied press statements warning that talks had dissolved because a key federal health official was going on vacation. Federal health officials have denied the claims and said they remain in contact with the state.
The negotiations over the hospitals funds, known as the low-income pool, have spilled over to Medicaid. Advocates say the hospitals wouldn't need as much federal funding if the state expanded Medicaid to 800,000 Floridians because the hospitals would have more paying customers. The federal government has offered to pay the entire Medicaid expansion bill for the first few years and then phase down its funding to 95 percent, but Scott and House Republicans are concerned officials won't make good on that promise.
Scott, who started his political career running TV ads against the federal health law, shocked many when he came out in support of Medicaid expansion in 2013 in an emotional speech, calling expansion a compassionate and common sense solution. He's since backed away, saying in recent years that he has other priorities but wouldn't stand in the way if the Legislature acted.
"Our priority is to cut more than $600 million in taxes this session and get K-12 education funding up to record levels while holding the line on college tuition. We still have several weeks left for budget negotiations; however, 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 first released to The Associated Press.
The growing feud over the hospital funds and Medicaid expansion has flustered Tallahassee lawmakers as they try to finalize a new state budget before the end of the session on May 1. The House and Senate budgets are currently $4 billion apart with the Senate including plans to take federal money to expand Medicaid.
Senate Republicans have stressed they also do not want to expand a broken Medicaid system and have crafted a replacement program that would take billions in federal funds so Medicaid recipients could purchase private insurance through vouchers.
The bill would offer coverage to adults aged 19 to 64 and who earn up to 138 percent of the federal poverty level, or about $33,000 for a family of four. The legislation would eventually require enrollees to pay monthly premiums. It also includes a requirement that participants work or go to school.
Senate President Andy Gardiner countered that the proposal offers "conservative guardrails that would bring the program to an end if the federal government fails to meet its obligations to Florida."
Senate leaders have warned they will not vote for a budget if it requires large cuts to hospitals. But House Republicans, who are opposed to any expansion of Medicaid, have contended that the federal government could renew the hospital money without expanding Medicaid coverage.
House Democratic Leader Mark Pafford criticized Scott's office for blaming the stalled negotiations on the feds.
"The governor may have some egg on his face and I think it's absurd to claim that the federal government has somehow not lived up to its bargain," he said.
Pafford is optimistic that a Medicaid expansion bill will be heard before session ends, whether it's on the floor on in a back room during budget conference committee. He predicted Scott's "cold feet" would not deter the Senate from "continuing to do the right thing."
The news that Scott now has problems with Medicaid expansion didn't surprise top senators.
Sen. Tom Lee, the Brandon Republican in charge of the Senate budget, held a nearly hourlong meeting last week with Scott, where the GOP governor talked about health care, but didn't discuss or show support for the Senate plan.
"It was clear to me that he wasn't supportive of Medicaid expansion," Lee said.
Lee, however, said that if legislators do not address health care funding issues, including the Senate proposal, it could make it difficult to find agreement on other issues that Scott wants passed.
Senate President Gardiner agreed.
"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," he said in a statement.