Florida Gov. Rick Scott reverses stance on Medicaid. Win for White House?

Florida Gov. Rick Scott on Wednesday said he will support expansion of his state’s Medicaid program to cover an additional one million low-income Floridians. It was a sudden and complete position reversal for GOP Governor Scott, who has been a fierce opponent of President Obama’s Affordable Care Act, which generously subsidizes Medicaid expansions as a major means of providing more Americans with health insurance nationwide.

Scott said that he had gained a new perspective on the issue following his mother’s death last year.

“Before I ever dreamed of standing here today as governor of this great state, I was a strong advocate for better ways to improve healthcare than the government-run approach taken in the President’s health-care law,” he said at a news conference. “I believe in a different approach. But, regardless of what I or anyone else believes, a Supreme Court decision and a presidential election made the president’s health-care mandates the law of the land.”

Wow. In terms of political health-care news, this is about as big as it gets. Is Scott’s decision a major victory for the White House?

Maybe. We qualify the statement only because Scott’s move does not make Florida Medicaid expansion a done deal. The legislature must still approve it, and that’s not certain. The speaker of the Florida House, Will Weatherford, insisted to National Review Online Thursday that his chamber’s support is far from assured.

Republican Weatherford, who opposes to the move, says a bipartisan select committee of state lawmakers is now looking into the matter. “It’s completely incumbent on the legislature,” he told NRO’s Betsy Woodruff.

Still, if Scott’s decision prevails it will be a major blow to the hopes of conservative Republicans who are aiming to curtail or derail “Obamacare” via state inaction. On Thursday they were describing Florida Medicaid expansion as the equivalent of a white flag of surrender, given that Scott had campaigned and won office as a committed Obamacare foe. Scott had vowed to not expand as recently as last July, when the Supreme Court ruled that states did not have to make such a move.

But at the moment the Florida governor’s approval ratings are abysmal, in the 30 percents, and he’s facing a tough reelection bid in 2014. That’s what swayed his decision, according to many on the right.

“I am terribly disappointed in his decision ... Governor Scott knows this is not the right thing to do,” conservative Erick Erickson wrote Wednesday at RedState.

Texas Gov. Rick Perry and Louisiana Gov. Bobby Jindal, two other Republican governors who have vowed to resist Medicaid expansion, should not follow Scott’s lead and now cave, added Erickson.

“Might as well let Florida roll that rock up the hill and take advantage of Governor Scott’s terrible mistake,” Erickson wrote.

Medicaid is a giant state/federal entitlement program which has long covered medical costs for the lowest income Americans. Under terms of Obama’s health-care law, states that raise eligible incomes to 138 percent of the poverty line and allow many more participants in the program will have their additional costs picked up by Washington for three years. After that the federal government has said their subsidy will cover 90 percent of state costs.

Currently, Washington pays only half the cost of Medicaid programs, so the expansion is a fiscal good deal for states, particularly those such as Florida, which have a high percentage of uninsured residents. Conservatives see the expansion as creeping federal control, however, and point out that in an era of curtailed government spending Washington’s proffered subsidies could easily disappear.

Scott’s decision only adds to the perception that Republican governors are split into two camps over dealing with the ACA’s provisions, Politico pointed out Thursday. On one side are pragmatists such as New Jersey’s Chris Christie, Ohio’s John Kasich, and New Mexico’s Susana Martinez. All represent states won by Obama in 2012, and all have agreed to Medicaid expansion.

On the other side are ideologues, generally southern governors in deep red or red-leaning states. They include Perry, Jindal, Nikki Haley of South Carolina, and Bob McDonnell of Virginia.

“It’s an intra-party struggle that mirrors the same fight that’s engulfed the Republican Party since Election day, pitting anti-Obama hardliners against those concerned with appealing to a broader swath of voters,” wrote Politico’s David Nather and Jason Millman.

For the anti-expansion holdouts one problem is that rejecting Washington’s Medicaid subsides does not lower their residents’ federal taxes. So Texans, Louisianans, and South Carolinians will help foot the bill for Florida’s new Medicaid beneficiaries without getting any US largesse in return.

That’s why from a purely logical point of view Scott made the right decision for his state, wrote Slate’s Moneybox columnist Matthew Yglesias. He called it a “simple collective action issue”.

“Perhaps all states declining to expand would be better than no states declining to expand, but if some states expand and others don’t you clearly want to be among the expanders,” he wrote.