When it comes to ObamaCare's expansion of Medicaid, it may seem like a matter of simple logic for states to take the money that's on offer. It would both help their most vulnerable citizens and pump lots of money into local economies.
Alas, logic and the contemporary Republican Party have little relation to each other, so most GOP-controlled statehouses have turned down the offer. But few have done so in a more clownish manner, or exposed the contradictions in the Republican position more clearly, than Florida Gov. Rick Scott.
Scott has flip-flopped on Medicaid, first opposing it, then supporting it, then opposing it again. This is bad, if not entirely unusual, political behavior. But Scott was particularly shameless, citing his recently deceased mother as his justification for suddenly embracing the expansion in 2013.
As he has now revealed, however, Scott was lying on his mother's grave. He pretended to embrace the Medicaid expansion to secure a federal waiver for privatizing Florida's Medicaid system, then quietly dropped his support once the waiver was granted. (The Obama administration's decision to give the quid without first getting the quo, given who they were dealing with, was not its finest hour.)
So Scott used his deceased mother as a shield to lie about his motives in order to funnel federal taxpayer money to Florida businesses, then reneged on his part of the deal, leaving many poor Floridians to needlessly suffer and in some cases die. All par for the course for Scott, who before entering politics oversaw a massive amount of Medicare fraud as CEO of a large for-profit hospital operator.
At this point, one could say that, rank dishonesty and opportunism aside, at least Scott is standing on principle. He is turning down federal dollars to protect state sovereignty. Not a very attractive principle, but at least a principle, right?
Nope. Before the Affordable Care Act, the federal government made money available to states to create Low-Income Pools (LIP) that would reimburse hospitals that treated patients who couldn't afford to pay for emergency services. Florida is receiving more than $1 billion a year in federal funds from LIP. The ACA, however, makes the LIP obsolete. It addresses problems of uncompensated hospitals by expanding Medicaid, greatly reducing the number of patients who cannot pay their bills.
The federal government has told Florida that it will not make the LIP funds available, pointing to the Medicaid funding which remains available. But Scott wants to have his cake and eat it, too. Not only is he demanding that the federal funding continue, he has actually filed a frivolous lawsuit arguing that the federal government is obligated to give Florida the LIP money. The Obama administration, having been burned by Scott already, is unmoved.
This lawsuit builds on the Supreme Court's already shaky holding that allowed states to opt out of the expansion, pushing it to an extreme that would be too absurd even for the Roberts Court. It has virtually no chance of succeeding.
But the decision to file it is instructive. On the one hand, Scott is arguing that taking an extraordinarily good offer from the federal government to insure its poor citizens would be an intolerable intrusion on the sacred sovereignty of the state of Florida. On the other hand, Scott is arguing that Florida has a right to another source of federal tax dollars for health care.
There is, in other words, no actual principle involved here — not even a bad "states' rights" one. It's just pure partisan politics, with Florida's poor people being punished as a result.
As Michael Hilzik of the LA Times observes, Scott's disgraceful behavior reflects broader trends in Republican governance. The decision of Republican officials at the state level to reject the Medicaid expansion, while misleading their constituents about the dread ObamaCare, continues to have disastrous results for their citizens.
The ensuing mess in Florida — where a huge hole has been blown in the state budget because anti-ACA fanatics won't take the Medicaid expansion — does at least provide a glimmer of hope for the longer term. Red-state legislators may not particularly care about the many poor people being needlessly denied access to medical care. But they will start to increasingly care about the medical professionals and hospitals who are also being screwed. Once Obama leaves office, it's likely that more and more states will grudgingly take the federal money.
In the meantime, however, the consequences of misrule in these states will continue to be grim.
