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Republican Governors Rethink Opposition to Medicaid Expansion

February 21, 2013 at 12:00 AM EDT
At first, many Republican governors actively opposed expanding the Medicaid program and said they would not participate. Now, some of them, including Florida Gov. Rick Scott, have reconsidered. Judy Woodruff talks to Paul Howard of the Center for Medical Progress at the Manhattan Institute and Ron Pollack of Families USA.

JUDY WOODRUFF: And we turn to the battles playing out over the health reform law and particularly the expansion of the Medicaid program. Many Republican governors have long insisted they wouldn’t participate.

But some of those more prominent opponents are shifting their position. Now that includes the governor of the state that first brought suit against Medicare.

MAN: Gov. Rick Scott.

JUDY WOODRUFF: Florida’s Gov. Rick Scott has been one of the most vocal critics of President Obama’s health care law.

GOV. RICK SCOTT, R- Fla.: This is going to be devastating for patients.

JUDY WOODRUFF: But, yesterday, he reversed his decision to block the expansion of Medicaid.

RICK SCOTT: While the federal government is committed to paying 100 percent of the cost, I cannot, in good conscience, deny Floridians that needed access to health care. We will support a three-year expansion of our Medicaid program under the new health care law, as long as the federal government meets their commitment to pay 100 percent of the cost during this time.

JUDY WOODRUFF: Scott, up for reelection next year, is the seventh GOP governor of late to accept the Medicaid expansion. Arizona’s Jan Brewer, Ohio’s John Kasich and Michigan’s Rick Snyder have also accepted the expansion.

Scott’s move is also significant because Florida has one of the nation’s highest levels of uninsured residents. More than a million people could be added to the state’s Medicaid rolls, potentially funneling an estimated $73 billion dollars in federal money to the state over a decade.

Medicaid, the joint federal and state program that provides health coverage for low-income families and those with disabilities, is key to the president’s Affordable Care Act. The Congressional Budget Office projects 12 million Americans will gain coverage through Medicaid expansion. Starting in 2014, the federal government will pick up 100 percent of the cost. By 2017, the government’s share starts to ramp down, so that by 2020, moving forward, Washington will pay 90 percent of the tab, with states picking up the other 10 percent.

But many Republican governors said this summer they wouldn’t opt into the Medicaid expansion after the Supreme Court ruled that states could opt out and not be penalized. Texas Gov. Rick Perry was among them. His state leads the nation in the number of uninsured residents, some six million.

GOV. RICK PERRY, R- Texas: The idea that we’re going to expand what we know is a failed economic program is — but we’re not going to do it in the state of Texas.

JUDY WOODRUFF: To date, at least a dozen Republican governors are declining to take part in the expansion. And even in states like Florida, it still must be approved by state legislatures.

To clarify, Florida was the first state to bring suit against Obamacare.

JUDY WOODRUFF: We get two views. Paul Howard is senior fellow and director of the Center for Medical Progress at the Manhattan Institute. It’s a conservative policy research center. And Ron Pollack is executive director of Families USA, a health care consumer advocacy group which worked to help pass the law.

And, gentlemen, we welcome you both to the NewsHour.

RON POLLACK, Families USA: Thanks for inviting us.

JUDY WOODRUFF: Ron Pollack, let me start with you. What’s your reaction to this announcement from Governor Scott?

RON POLLACK: Well, I think it’s a hallelujah moment. I think it’s terrific.

I think this means that we’re going to see states all across the country, I think, follow what Gov. Scott has done. As you aptly indicated, Florida was the state that first went to court to challenge the constitutionality of the Affordable Care Act. It was that case that went to the Supreme Court.

So this is a big deal. And, mind you, for Floridians, this is enormous, because if you look at the eligibility standards that exist today, they’re really meager. For parents, for example, in a three-person family, they’re ineligible for health coverage under Medicaid if they have incomes over $11,000 dollars.

For people who are — don’t have any children, it makes no difference what their income is. They’re ineligible for Medicaid. So this would be an improvement.

JUDY WOODRUFF: And I want to ask you about eligibility.

But, Paul Howard, how do you see this decision by Gov. Scott in Florida?

PAUL HOWARD, Manhattan Institute: Well, I think it’s obviously a political decision on the part of the governor who’s facing low approval ratings in the state and he’s trying to do something to elevate his stature and perhaps move to the center.

I think it’s a mixed bag for Florida. Obviously, you want to expand coverage to low-income Americans, but Florida as a whole right now spends about a third of its budget on Medicaid. It’s the largest expenditure and it’s crowding out other spending on things like education and infrastructure. And that’s a story that is repeated across the country, not just in Republican or GOP states like Florida, but in New York and Illinois and California.

So this is an ongoing challenge that the ACA really doesn’t address, and it’s going to be a problem for the state going forward.

JUDY WOODRUFF: Paul Howard, why do you believe — you said you think it was mostly done for political reasons. Why do you say that?

PAUL HOWARD: Well, you have the governor facing a reelection, as you noted, next year, with low approval ratings right now.

He’s also moved recently to give bonus payments to state workers and to teachers. I think he saw this as a moment to try and reach across to the center or to the left in Florida and boost his reelection chances. It’s an enormous flip-flop for the governor, given the stance that he took earlier against Obamacare and the Medicaid expansion. It looks just to be purely politically expedient.

JUDY WOODRUFF: So, Ron Pollack, coming back to you on this question of politics, do you believe, as Mr. Howard does, that that’s the reason?

RON POLLACK: Well, it’s a factor.

Why would a governor from Florida say to his citizens, we’re going to spend tax money, we’re going to send it to Washington, and that money that goes to Washington should go to California and to New York and to Ohio to help their folks get health care coverage, but we’re not going to do it in Florida?

JUDY WOODRUFF: And, in fact, that’s the argument some of the other Republican governors have made to change.

RON POLLACK: Absolutely.

JUDY WOODRUFF: Let’s get back to who benefits from this. You were touching on that a minute ago. I think you used the term meager. The benefits are not huge in Florida.

Just — I mean, to put in the just a few words, how much benefit does this mean for people — low-income individuals in the state of Florida?

RON POLLACK: This is going to be a lifeline.

So, all together, in terms of people eligible for coverage as a result of this expansion, it’s 1.8 million people. Now, quite a few less might get it because they may not know about it. They have to get enrolled, but this means these folks who are newly eligible for coverage for the first time can get good coverage and they will be able to afford it. So this is a big deal.

JUDY WOODRUFF: Paul Howard, how do you see that? How do you see the difference this is going to make for those individuals either with disabilities or low-income?

PAUL HOWARD: Well, obviously it’s a challenge.

You know, nationally, the Congressional Budget Office pointed out that most of the people who are going to be affected by the enrollment under Obamacare, under the Affordable Care Act, are young and healthy. So the sliver of patients that have chronic diseases or chronic illnesses you really want to reach out to, it’s a small portion of people that get expanded coverage.

I caution just a little bit. Medicaid faces challenges in many states because it has low reimbursements for primary care physician enrollment. So Medicaid patients, they have good coverage on paper. They’re going to have challenges reaching specialists and getting care for complex conditions. So that’s a bit of a mixed bag here.

It looks terrific on paper, good coverage on paper. The more complex problems, the people we should be most concerned about, they’re going to have the most trouble getting really high-quality care.

JUDY WOODRUFF: So, are you saying you dispute that 1.8 million number we just heard from Mr. Pollack?

PAUL HOWARD: No, I don’t dispute the number.

What I’m saying is that of the people who are uninsured in states like Florida, the vast majority of them are going to be young and healthy. The CBO has said that in its most recent update in its estimate of Medicaid costs. So these are young, healthy people. They don’t have insurance.

We need to find a way to get those people covered, but Medicaid as a vehicle for getting them that coverage, from my perspective, is the wrong way to go.

JUDY WOODRUFF: How do you respond?

RON POLLACK: Well, this covers people throughout the age spectrum. It’s not just young people. And, by the way, I think getting young people into coverage is terrific, because these are folks who are less likely to need care, so the costs for those people is less expensive.

But this is going to help people whether they’re 40 or 50, so it’s not simply young people. This is going to be across the board. This creates a floor under which nobody can fall in terms of their eligibility for Medicaid.

JUDY WOODRUFF: Paul Howard, how about the rest of Obamacare? What is left now for the states to decide? We know there are the health care changes. And without getting into all the detail about that, how much of an advance is this for getting Obamacare instituted?

PAUL HOWARD: Look, from the perspective of the states, I think Ron was absolutely right about this. States are looking at kind of a no-win situation.

If they don’t expand under Medicaid, they’re looking at state funding, their tax dollars going to other states that have expanded. The law is going to face a number of challenges. I think that the exchanges are going to be an ongoing challenge for the law. A number of insurers have said that they are not going to participate.

The cost problem of coverage is still something that hasn’t been solved. As CBO and others, other organizations, independent analysts have noted, health care costs continue to rise. And then finally the problem of doctor access, physician access under the law is going to be a challenge. So implementation is going to go forward.

I think a number of states are going to continue to hold out and let the federal government operate the exchanges and see what happens. I think you are going to continue to see a mixed bag on the Medicaid expansion as well. So I think from here on out, we are going to see a number of challenges on implementation and cost. They’re not going to be resolved to anyone’s liking in the next few years.

JUDY WOODRUFF: How do you see, Ron Pollack, the — what’s left of Obamacare, what’s left to be done and accomplished?

RON POLLACK: Well, now we have to implement this legislation effectively.

You know, since the legislation passed in 2010, we had a very contentious debate, and there was a question as to whether the Affordable Care Act would survive. Well, the Supreme Court held that it’s constitutional. President Obama won reelection. So now it’s clearly the law of the land.

And for all of us now, we have got to try to make sure it gets implemented effectively state after state. I think that will happen, and it certainly will happen in a timely manner starting January 2014.

JUDY WOODRUFF: And you’re saying what’s happened today in these other states, especially those with Republican governors, which were not expected potentially to go along with Medicaid expansion, this will make a difference?

RON POLLACK: Oh, I think it’s going to make a huge difference. I think the dominoes are falling.

I think you are going to see many Republican governors doing it. And they have to do it, because it’s silly not to, 100 percent paid by the federal government, and the states are saving money in terms of their costs for uncompensated care. This is a good deal.

JUDY WOODRUFF: All right, we’re going to leave it there.

And I know we’re going to be coming back to this in the future.

Paul Howard in New York, Ron Pollack in Washington, we thank you both.

RON POLLACK: Thank you.

PAUL HOWARD: Thank you.