If former Florida Gov. Charlie Crist gets his old job back, he promises to expand Medicaid to roughly 1 million low-income residents by calling a special session of the Legislature or through an executive order. If Gov. Rick Scott is re-elected, the decision will be once again left to the Legislature with little meddling from him.
The debate over Medicaid expansion, a key part of President Barack Obama's health law, has been contentious in the campaign leading up to the Nov. 4 election. The Sunshine State has one of the highest uninsured rates in the country. That pent-up demand was clear as nearly 1 million Floridians bought private insurance through the federal health marketplace when it opened a year ago. But another million fell into a gap: too poor to qualify for tax credits in the marketplace, yet earning too much to qualify for Medicaid.
The federal government has agreed to pay 100 percent of the Medicaid expansion costs for three years — about $50 billion over 10 years — and start phasing down to 95 percent in 2017. Scott and state Republicans have rejected the measure amid concerns that the feds will not make good on that promise, leaving the state on the hook for the tab.
Crist, who brings up the topic on most campaign stops, says one of the first things he'll do if elected is call a special session, although it's unlikely the Republican-controlled Legislature would cooperate. Crist was a Republican when he became governor in 2006, but became an independent before running for the U.S. Senate in 2010. He is now a Democrat.
"I would prefer to work with our partners in the Senate and the House ... but if they would be unwilling, I would be willing to try to do it by executive order," Crist said. "Rick Scott won't lift a finger to get it done."
In Florida, executive orders are a gray area which "potentially have a lot of power, but generally they are used for ceremonial and more PR kinds of things," said Carol Weissert, a Florida State University political science professor.
Governors don't usually use it for path-breaking policies like Medicaid expansion, she said. And even if Crist followed through, the Legislature could overturn it.
Scott, on the other hand, says Medicaid expansion requires legislative action.
"Of course Charlie favors (an executive order), because that is what President Obama does — refuses to work with legislators and just goes his own way and issues decrees. I guess Charlie is telling us that he's going to be just like Obama," Scott said in a statement. He declined a meeting with AP reporters before the election and also declined a phone interview for this story, but his staff returned email questions.
Scott has gone back and forth on Medicaid expansion. A former CEO of the HCA hospital chain, Scott entered politics in 2009 running national cable TV commercials criticizing the president's plan. Florida led the way in challenging the ACA in a lawsuit that went all the way to the Supreme Court. Scott also made the rounds on conservative talk shows repeatedly expressing concern that expanding Medicaid would put too much of a strain on Florida taxpayers.
But he made an about-face decision to support Medicaid expansion last year, calling it the "compassionate, common sense step forward" and said rejecting federal funds and ponying up state dollars for health coverage puts a double burden on Florida taxpayers.
Yet Scott never used his political clout, letting the Legislature duke it out, saying he hoped the members would agree to expand the program with little indication that he was invested in making that happen.
He's since backed away from his support, saying earlier this year that he wouldn't stand in the way of the Legislature passing it while feds fund 100 percent of the bill.
"I said that I would only agree to expand Medicaid if it did not cost Florida taxpayers," Scott said in an email. "It would be wrong to make promises to provide care that the state could ultimately not afford or sustain."