Crist Pushes Medicaid Expansion, Scott Remains Low Key


TALLAHASSEE, FLORIDA — Theoretically, Gov. Rick Scott and former Gov. Charlie Crist agree on one thing in their hotly contested gubernatorial race — Florida should expand Medicaid under the Affordable Care Act, better known as Obamacare.

Charlie Crist
Charlie Crist

But Crist, the Republican-turned-Democrat, said the difference is that he would fight to extend Medicaid to hundreds of thousands of Floridians, while Scott, a Republican who first ran for office as a fierce critic of the federal health-care law, has been lukewarm since a surprise turnaround on the Medicaid issue last year.

His heart’s not in it,” Crist said, adding that if elected, he would call a special session, sign an executive order or use budget vetoes to push the GOP-led Legislature to pass Medicaid expansion.

Democrats have long decried the House’s refusal to accept $51 billion over a decade from the federal government to expand access to health care coverage via Medicaid or a similar program. Estimates are that 800,000 to 1 million uninsured Floridians could gain coverage as a result.

But House Republican leaders made clear in 2013 they wouldn’t accept the money, arguing that the federal government couldn’t be trusted to keep its commitment to Florida. 

Will Weatherford
Will Weatherford

“This is classic Charlie Crist, who’s desperate right now because I think he’s in trouble in his race,” said House Speaker Will Weatherford, R-Wesley Chapel. “And he’s throwing out a lot of ideas, trying to garner some support and create and stimulate activity with the Democratic base.”

Scott, too, has to think about his base. When he came out in favor of expanding Medicaid just days before the 2013 session, calling it a “compassionate, common-sense step forward,” the move stunned Florida’s political world.

Republicans, including Scott, had spent more than two years fighting the Affordable Care Act, which passed in March 2010. The fight included a Florida-led legal challenge that ended up in a landmark U.S. Supreme Court case. Justices upheld most of the law, but said states must be able to decide whether to carry out the law’s Medicaid expansion.

Scott cited that ruling, along with the 2012 re-election of Barack Obama, when he announced his support for Medicaid expansion in February 2013. He said the combination had cemented Obamacare as the “law of the land.” He said he still believed the best way for people to get health coverage is through their jobs, but that his decision was aimed at making sure all Floridians gained access to care.

Scott has mostly ignored Medicaid expansion since.

Nan Rich
Nan Rich

“He supported it for about five minutes,” said former Senate Minority Leader Nan Rich, who lost the Democratic nomination to Crist in August. “When you support something, you work to make it happen.”

The governor’s surprise announcement came hours after the Obama administration sent a letter to the state indicating it would approve a proposal to shift almost all Medicaid beneficiaries into managed-care plans. Scott and Republican legislative leaders had long championed the controversial idea, which is now in effect statewide.

As of Oct. 1, there were 2,947,812 Florida Medicaid recipients either enrolled in managed-care plans or pending enrollment, according to the Agency for Health Care Administration. That is the vast majority of the Medicaid population.

Asked if Scott would support Medicaid expansion in a second term, Scott campaign spokesman Greg Blair wrote in an email, “We have already accomplished historic Medicaid reform that improved access and quality while controlling costs. We got a waiver from the federal government to make our system more accessible and affordable, and our Medicaid system is already better off today than it was before we took office, when it was growing at three-and-a-half times our general revenue. And Charlie Crist did nothing about it.”

Asked if Crist’s charge that Scott hadn’t fought for Medicaid expansion because his heart wasn’t in it, Blair replied, “There is no doubt our health care system needs to be improved, but we cannot say that the answer is Obamacare — a bad law that just seems to be getting worse as people learn that they could lose their doctor and their insurance while premiums continue to increase.”

medicaid-180By the same token, Weatherford questioned Crist’s commitment to providing health care. “Gov. Crist had his opportunity to be the governor,” he said. “If he thought more people should have had government-subsidized health care, why didn’t he propose a plan back then?”

A House plan in 2013 would have offered $2,000 subsidies to targeted groups of low-income residents to help them buy health coverage, but rejected the possibility of drawing down federal money that would otherwise have been used for Medicaid expansion.

A Senate plan, which Scott supported, would have used the federal money to offer private health insurance to people with incomes up to 138 percent of the federal poverty level. Senate Republicans were careful to say the plan would not be a Medicaid expansion, but it would have targeted the same low-income people who would have otherwise qualified under a Medicaid expansion.

Neither plan passed.

Steve Crisafulli
Steve Crisafulli

Crist said if he’s elected, the upcoming transition from Weatherford to Speaker-designate Steve Crisafulli, R-Merritt Island, could open the door to a new proposal.

“I know Steve Crisafulli, and I think that he is less adamant than Will Weatherford has been on this issue,” Crist said. “And so I have some hope that we can make some inroads, and just reach out to the House and Senate, Republican and Democrat alike, and appeal to the better angels in them.”

But Crisafulli, who supported Weatherford and other House leaders on the issue, dismissed that possibility in an email. Crisafulli will become speaker in November if he wins re-election in his Brevard County district.

“President Barack Obama crafted a confusing, unworkable, expensive and ineffective healthcare plan,” Crisafulli wrote. “Charlie Crist, who once opposed it, is now Obama’s biggest cheerleader. Not everyone is like Charlie. The fact of the matter is I have not heard from a single Republican member or candidate who supports the Obamacare expansion of Medicaid.”