Experts: Florida's Medicaid turnaround paves the way for Obamacare
Supporters of Barack Obama's health reforms are hailing Florida governor Rick Scott's decision to abandon his opposition to a core provision of Obamacare as a "tipping point" likely to force the hand of other Republicans still attempting to block full implementation of the law.
Scott's climbdown – in saying he now backs expansion of Medicaid to an additional 1.3 million people in Florida – is a significant retreat from a year ago when his state was at the forefront of the failed supreme court fight to overturn the Affordable Care Act.
Groups backing the reforms say the move is likely to pressure other Republican governors to follow suit.
"The fight over Obamacare is over. Rick Scott recognised that, and that's why he made a decision based on the merits, and that's why his decision is such an important tipping point," said Ethan Roman, executive director of Health Care for America Now, a coalition of more than 1,000 groups, including doctors, trades unions and business interests.
"As each of the leading opponents of Obamacare embrace fully participating in Medicaid, it provides more cover for the rest of the governors and it puts pressure on them to do the right thing. It spotlights their decision-making."
The supreme court upheld Obamacare last year, but gave state governments the right to opt out of a provision expanding Medicaid coverage for the poor. The measure is central to ensuring healthcare coverage for some of the most vulnerable Americans by including in it anyone who lives on less than 133% of the federal poverty level.
At the time, Scott, pictured, and other Republican governors said they would stand by their refusal to have anything to do with the health reforms as a matter of principle, even though the federal government was paying almost the entire cost of the expanded coverage.
"Since Florida is legally allowed to opt out, that's the right decision for our citizens," the governor said last summer.
But it became increasingly difficult for Republican governors to explain why they were rejecting a benefit residents of their states were paying for in other states through federal taxes. Under the reforms, the federal government picks up almost all the cost of expanding Medicaid for the next decade, and 90% after that.
Scott recognised the dilemma in announcing his reversal, which he called a "compassionate, commonsense step forward".
"Our options are either: having Floridians pay to fund this programme in other states while denying healthcare to our citizens, or using federal funding to help some of the poorest in our state with Medicaid as we explore other healthcare reforms," he said. "While the federal government is committed to paying 100% of the cost, I cannot in good conscience deny Floridians that needed access to healthcare."
Scott, who now favours a trial period of three years, said he was also moved by his mother's recent death after raising five children "with very little money".
"Losing someone so close to you puts everything in a new perspective, especially the big decisions," he said.
But Scott acknowledged he faced a political reality that the healthcare reforms are here to stay following Obama's re-election. "This is not a white flag of surrender to government-run healthcare," he said. "We now have a supreme court decision and we have an election that says this is the law of the land."
Those arguments have already persuaded other opponents of Obamacare -such as Arizona's governor, Jan Brewer, who famously wagged her finger at the president over her objections to the law, and the Republican governors of Michigan, Nevada and Ohio — to sign up for the expansion to Medicaid. But others are still holding out, notably Rick Perry of Texas – whose state has the highest proportion of people without health insurance in the US – Bobby Jindal of Louisiana and South Carolina's Nikki Haley.
Rome said that was as much about political ambition as what is good for their states. "I think Scott came to recognise that accepting federal funds to cover 1.3m people in his state was the best thing to do for those people, for hospitals, for businesses and for government because this isn't about politics, it's about what makes good sense," he said.
"Sadly, if you want to know who's likely to run for the Republican presidential nomination in 2016, you can look at some of those governors who have said they won't participate. But I think it's only a matter of time. As each day passes, the hyperpartisan political nature of the decision made by Rick Perry, Bobby Jindal and others becomes more clear. The consumers, the hospitals and the businesses of those states are simply not going to tolerate their governors making a seriously bad decision based on self interest and politics."
Although Scott's decision is politically significant, it still has to be approved by Florida's Republican-controlled legislature, where there is lingering resistance to Obamacare.
"Governor Scott has made his decision and I certainly respect his thoughts. However, the Florida legislature will make the ultimate decision," said the Republican speaker of the Florida House of Representatives, Will Weatherford.
"I am personally sceptical that this inflexible law will improve the quality of healthcare in our state and ensure our long-term financial stability."
Already, conservative organisations such as Americans for Prosperity are agitating for the legislature to defy Scott.
States do face some additional costs, but they are relatively low compared to the benefits received. According to a Kaiser Family Foundation report in November, the expanded coverage will cost the federal government $952bn while the states are on the hook for $76bn. Although the cost to a state such as Texas will be about $4bn, a large part of that is likely to be offset by a reduction in the number of patients who receive treatment at hospital emergency rooms without the funds to pay.
© Guardian News and Media 2013
[Correction: The headline originally referred to Medicare]