How To Cure A Tea Party Hangover: Rick Scott Accepts Medicaid Expansion

On the same day Florida governor Rick Scott announced that his state would accept Medicaid expansion, “What’s It Like to Wake Up From a Tea Party Binge? Just Ask Florida!” by Mother Jones’ Stephanie Mencimer, was spreading like wildfire across the web.

“To get Medicaid in Florida, you have to make less than $3,200 a year,” Mencimer pointed out, “and the state seems set to reject Obamacare subsidies that would fix that.”

The state has the second highest rate of uninsured residents in the country, and recently suffered the worst tuberculosis outbreak in 20 years, a fact that the state apparently attempted to conceal.

Despite this, Florida led the 26-state lawsuit against the law that resulted in the Supreme Court upholding the individual mandate, but allowing states to opt out of Medicaid expansion.

So why suddenly — after continually lying about the costs of Medicaid expansion — has Rick Scott decided that he would accept subsidies from the big, evil, OBAMANATION of a federal government?

As Mencimer points out, Florida is coming out of its Tea Party hangover.

Scott’s approval rating has never broken 50 percent since he was elected governor in the Tea Party landslide of 2010. In late 2012, he was losing to generic Democrats by 4 percent, according to PPP Polls. A poll last month showed him losing to newly minted Democrat and former Republican governor of the Sunshine State, Charlie Crist, by a whopping 14 percent. So cut to a hastily called press conference at State House in mid-February.

“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 said Wednesday.

Scott is supporting a three-year acceptance of Medicaid expansion but will not make it a legislative priority. Still, this decision is huge for two reasons.

First, it signals a major rhetorical shift in Republicans — especially Republicans in states President Obama won — away from the Tea Party dogma of government getting out of the way to let business do business and poor people be poor.

Scott said that he was thinking of  the “poorest and weakest” Floridians. When he was campaigning against Obamacare as a “job killer,” he never expressed much concern for those on the edges of society.

Rick Scott isn’t the only Republican governor who has moved into the acceptance phase of the Obamacare mourning process. Arizona’s Jan Brewer has accepted Medicaid expansion, along with Rick Snyder of Michigan and John Kasich of Ohio.

“Well, I think it makes sense to bring this money home, and this money can provide health coverage for the poor – a great number of them who are working poor, individuals who make less than $15,415. [On] $15,415 – they can’t afford healthcare,” Kasich said during his recent State of the State address. “What are we gonna do, leave ’em out in the street? Walk away from them, when we have a chance to help them?”

Former Tea Party heroes are now offering the compassionate case for health care reform that Democrats have often been afraid to make.

And they’re doing it despite fierce resistance from the right, as New York magazine‘s Jonathan Chait notes: “For an enjoyable sampling of conservative apoplexy,” he writes, “try Philip Klein (‘waving the white flag is an accurate description of Scott’s decision’), Mario Loyola (‘the most grievous blow since the Supreme Court’s decision upholding Obamacare last year’), and Michael Cannon (‘will he sell out Florida’s job creators too?’).”

Klein points out that Scott’s decision will cost $58 billion over the next decade.

But if Florida didn’t accept expansion, its richest residents and medical device companies would still be paying the taxes that fund the Affordable Care Act, as Florida’s Medicare providers see a cut in their reimbursement rates that was supposed to be made up by the expansion of Medicaid.

Meanwhile, the state would see none of the cost management that’s designed to come from stopping the uninsured’s reliance on emergency room care.

This leads us to the second reason Scott’s decision is huge for the future of Obamacare.

Once a state accepts Medicaid expansion, it will be almost impossible for them to give it up, even as the federal government goes from paying 100 percent of the expansion down to 90 percent in 2020 for a pretty simple reason — voter self-interest.

Much of the Tea Party movement was fueled by seniors who feared losing their Medicare. Medicaid expansion creates a whole new class of voters who can rebel if the elimination of their benefits is sought.

Similarly, Medicare patients are also going to be punished in the states where expansion doesn’t happen or is rescinded after a few years. Medicare providers may begin declining new patients — or possibly even move to states where Medicaid expansion guarantees the reimbursements necessary to stay in business.

Chait calls Scott accepting Medicaid expansion the “death blow” to the Republican “repeal machine.”

Of course, conservatives still have a lawsuit that asserts that a fluke provision in the law says that federal health insurance marketplaces, which are being set up for the states that have rejected the law’s provision to offer their own, cannot offer subsidies. It’s unlikely the Supreme Court would maim the law that way after taking so much flak on both sides for its decision in 2012.

But the war for full Obamacare acceptance continues.

Governors from 12 states have turned down Medicaid expansion, meaning millions of Americans who could be getting health care, won’t be. Unfortunately, thousands of these working poor who earn too much to get Medicaid now will die — unnecessarily. And of course, many of the states that are opting out are the ones that need it the most.

Most of the governors rejecting the subsidies preside over bright red states. Wisconsin’s Scott Walker, who handily won a recall last year, and Pennsylvania’s Tom Corbett, who recently earned a record low approval rating, are the exceptions.

But Scott’s move shows that he anticipates the 2014 election being nothing like 2010. If he’s going to survive, the governor of Florida is going have to prove that he’s better at moving to the center than he has been at governing.

Photo credit: Gage Skidmore via Flickr.com