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Brewer Pulled It Off; Rick Scott Didn't

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Associated Press
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Earlier this year, both Govs. Jan Brewer of Arizona and Rick Scott of Florida surprised political pundits by coming out in support of Medicaid expansion. Both Republican governors had been fierce critics of the Affordable Care Act, but they said they favored the expansion because it would hurt the people of their state to turn down federal funds.

But the outcomes were quite different. Brewer muscled it through the Arizona Legislature, winning victory on Thursday after months of uncertainty and bare-knuckle politics. 

By contrast, Scott gave no visible sign of fighting for the Medicaid expansion when Speaker Will Weatherford and other House Republicans refused to go along.

Rep. Mark Pafford, D-West Palm Beach, said it's high time for Scott to show leadership on the issue, rather than flitting off to Paris. Scott should start by "taking the Speaker to the woodshed."

In both states, the people affected were those who have incomes at or below the federal poverty level. In Arizona, the number of uninsured who will be added to Medicaid is nearly 300,000; in Florida,  the Medicaid rolls would have grown by an estimated 1.1 million.

Because of a quirk in the Affordable Care Act, some of those 1.1 million -- those between 100 percent and 138 percent of the federal poverty level, or roughly between $11,500 and $15,000 in income --will be able to sign up for coverage through the federal marketplace with subsidies. It is to open Oct. 1, with coverage effective Jan. 1.

But the majority, those with incomes under $11,500, will be left out. That's around 700,000 people, according to the latest estimate  by the consumer group Florida CHAIN.

Brewer and Scott made similar arguments, saying that their states would be harmed if they turned away federal funds that fully cover the new Medicaid population for the first three years, gradually going down to 90 percent and remaining there.

In Florida's case, that amounts to an estimated $51 billion over 10 years. Meanwhile, as the Rand Corp.reported recently, states that turn down the Medicaid expansion will have higher state and local expenses in the coming years because of the decision.

Brewer pushed home the message that Arizona's tax money would just go to other states if her state  turned it down. She allied with business groups and health-care interests -- especially hospitals -- to barnstorm the state. She threatened to veto legislative leaders' pet bills if they didn't go along.

In other words, she played politics. Scott did not.

After the House's position became clear, when reporters asked Scott what he was doing to push for the Medicaid expansion, he said his discussions with lawmakers were private. He also said the expansion was not one of his priorities.

Rep. Mark Pafford noted the difference on his Facebook page and  released this statement to Health News Florida:

"Though his stance on health care expansion is on target, his role has been irrelevant thus far. It's time for him to lead, like Governor Brewer. Taking the Speaker Weatherford to the woodshed would be a good start.  Asserting himself. This is a serious issue that has life and death consequences, I don't know what the heck Governor Scott is waiting for."

For a lengthier account of what happened in Arizona, see the Huffington Post.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.