Scott Shocker: Let's Expand Medicaid!

Feb 20, 2013

Gov. Rick Scott at press conference
Credit Politico.com

Hospitals, consumer groups and Democrats celebrated Thursday as they recovered from shock over Gov. Rick Scott's change of heart on Medicaid expansion.

Tea Party leaders tweeted moans about betrayal.

Legislators reminded Scott it's not over yet.

And Medicaid HMO companies -- especially WellCare Health Plans Inc. -- started looking very good to investors. Stifel  analyst Tom Carroll sent a note titled "Lightning Strikes in Florida," saying Florida's move may influence other red states, with Texas as the most-sought-after plum. It has an estimated 11 percent of the group of would-be Medicaid eligibles; Florida has 6 percent.

Florida "is taking the money after much of the headline-grabbing, foot-stomping, states-rights idealism has faded," Carroll writes. "Economics must rule the day, and Florida is making the right decision."

Scott had hinted that if he got what he wanted from the Obama administration, he'd give the President's appointees what they want.

And so it came to pass on Wednesday.  In the late morning, a high-ranking Medicare official in Washington sent a letter saying Florida will be able to move virtually all Medicaid patients into managed-care plans, statewide.

Then just after 5 p.m., Scott came before the Capitol Press Corps to announce he wants to expand the Medicaid program as called for under the Affordable Care Act -- a 180-degree change in his previous firm opposition. See video replay.

“While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care," Scott said. 

He mentioned that the recent death of his mother had influenced his decision. He recalled that she had been forced to ask for charity care for his disabled brother even though she was a strong, proud woman. No one should be denied access to quality care just because they're poor, he said.

Scott's surprise made national headlines. It was the lead story on NPR's "All Things Considered" newscast on Wednesday afternoon; on Thursday all the major newspapers devoted considerable ink to it, including The New York Times.

Scott was the seventh Republican governor to agree to Medicaid expansion, and by far the most politically potent symbol of change.  A Politico analysis Thursday, noting the split among Republican governors, moved Scott from the "ideologue" column to "pragmatist."

Speaker of the House Will Weatherford lost no time reminding Scott in a press release that the Legislature plays a role in the decision.  In a press release, Weatherford, R-Wesley Chapel, said:

“Governor Scott has made his decision and I certainly respect his thoughts. However, the Florida Legislature will make the ultimate decision. I am personally skeptical that this inflexible law will improve the quality of healthcare in our state and ensure our long-term financial stability."

The Buzz blog from the Tampa Bay Times has more reactions on Scott's announcement.

Assuming the Legislature goes along with the expansion, about 1 million uninsured low-income Floridians will be able to get coverage through Medicaid, a joint federal-state coverage program for the poor. The income limit for enrollment will be raised to 138 percent of the federal poverty level.

It was an astonishing turnaround for Scott, who had many times vowed not to go along with any part of the health law. In fact, Scott's main campaign plank when he ran for governor was his vow to kill what he called "ObamaCare."

On Wednesday, Scott said he still didn't think the President's plan was the best way to fix the health-care system.  But he noted that it was upheld by the Supreme Court and Obama won re-election. "It's the law of the land," he said.

He suggested that Florida limit its expansion legislation to three years -- 2014 through 2016 -- when the federal government is paying 100 percent of the cost of expansion. Then the law would "sunset" and need reauthorization to continue coverage for the new Medicaid group.

"There are no perfect options," Scott said. "Our options are either having Floridians pay to fund this program in other states while denying healthcare to our citizens or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other healthcare reforms.

“Expanding access to Medicaid services for three years is a compassionate, common sense step forward. It is not the end of our work to improve healthcare.  And, it is not a white flag of surrender to government-run healthcare.

"I am committed to working every day to improve access to affordable, high-quality healthcare in Florida, while also protecting taxpayers and keeping our economy growing to create more jobs – which ultimately fuels the dreams of every Florida family.”

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Earlier, Scott announced that Florida had won its request to enroll virtually all Medicaid patients  into private managed-care plans. He called it "a great win for Florida."

Scott said statewide Medicaid managed care will give patients with chronic illnesses better coordination of care and help taxpayers by lowering costs.

The news that the federal Centers for Medicare & Medicaid had reached "agreement in principle" with Florida came in a letter from Cindy Mann, director of CMS' Medicaid office. The letter is addressed to Florida Medicaid Director Justin Senior, and is dated today (Wednesday, Feb. 20, 2013).

Mann wrote: "We have made significant progress in agreeing upon terms of a demonstration that will ensure access to high quality health care services for Florida's Medicaid beneficiaries. We are eager to continue working together and have reached agreement in principle on granting the waiver."

Florida needs a waiver of federal rules on Medicaid in order to require that enrollees in the joint state-federal program be members of managed-care plans. The 2011 Legislature passed the statewide plan for all but those who are developmentally disabled, and the state has been trying to get a waiver ever since.

Some consumer-advocacy groups and medical associations have raised fears that some of those who will now have to be in a managed-care plan are not likely to be good advocates for themselves to make sure they get what they need.

The first group of Medicaid patients to be enrolled will be frail elderly and disabled persons who are in nursing homes or who need a lot of assistance to remain in the community. The long-term-care waiver was issued earlier.

The waiver covered by today's letter is for all others. Mann's letter listed several "terms and conditions" that will need to be included in the waiver agreement, including quality-of-care measurement and strong monitoring. Read the letter here.

Florida CHAIN, a health consumer advocacy group, issued a statement reflecting mixed feelings:

"CMS and Florida appear to be moving in the right direction, but we will reserve judgment until we see the final document, should the waiver ultimately be approved," it said.

Because of consumer advocates' hard work and receptive ears in Washington, protections for enrollees are much stronger today than when the "experiment" began, CHAIN's statement said.

"We are encouraged by the inclusion of those protections and the movement toward a more transparent, inclusive process and more robust independent monitoring," the statement said. "We are hopeful that the final language and implementation will reflect what is most important – full access to quality health care for Medicaid beneficiaries with proper oversight.  

"What this is really all about is ensuring that the managed care plans are using public dollars responsibly by promoting better, more cost-effective care rather than cutting corners and limiting access to care. When people don’t get the preventive care they need, they end up sicker and in need of more expensive care.  "