Maggie Steber for The New York Times
Simar Singh, a medical student at Florida
International University, volunteers at a clinic that serves the poor
and uninsured.
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Times Topic: Health Care Reform
Maggie Steber for The New York Times
Dr. Edwin Bosa-Osorio of Miami said doctors too often have to take “the Plan B approach.”
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But it may not be so easy. A battle is brewing here in Florida, where Gov. Rick Scott
took to national television soon after the ruling to announce that he
would reject the expansion. Advocates for the poor and some players in
the health care industry — especially hospitals, a powerful political
lobby — intend to push back.
Hospital associations around the country have already signed off on cuts
to reimbursement rates under the health care law on the assumption that
the new paying customers they would gain, partly through the Medicaid
expansion, would more than cover their losses.
“If we’re going to walk away from that coverage, we’ll simply see those
dollars we contributed through cuts in hospital payments go to covering
people in other states,” said Bruce Rueben, president of the Florida
Hospital Association. “It’s a bad deal for people in Florida if it plays
out that way.”
Given Florida’s size — it is the fourth most populous state in the
nation, and more than 20 percent of its 19 million residents lack health insurance
— the implications for Mr. Obama’s goal of insuring most Americans are
significant. And Florida’s importance as one of the biggest battleground
states in the presidential race adds potency to Mr. Scott’s clash with
the Obama administration. Supporters of the law here have hurried to
paint the Medicaid expansion as crucial not just morally, but
economically.
But there is noticeable frustration with the White House from some.
State Senator Nan Rich, a Democrat running for governor in 2014, said
the administration needed to do a better job of countering state-level
opposition.
“The Obama administration needs to be more forceful in going out there
and explaining what is true and what’s not,” she said.
Despite the governor’s statements, leaders of the Republican-controlled
state Legislature have not outright rejected the expansion, saying they
will study their options over the coming months before making a
decision.
“At the end of the day, we are going to take a rational approach that
reflects the interests of Floridians, protects their hard-earned tax
dollars and uses common sense, ” said Representative Will Weatherford,
the incoming House speaker.
That more measured approach may reflect, in part, mixed public sentiment
about the health care law. The boos that met Mitt Romney’s vow to
repeal the law in a speech on Wednesday at the N.A.A.C.P.’s annual
convention in Houston were a reminder that while Republicans believe
strident opposition is a winning strategy, it may not be so clear-cut.
Mr. Scott describes Medicaid as a dysfunctional program, saying the
portion of the state budget devoted to it is growing at more than three
and a half times the rate of general revenues. The program currently
costs about $21 billion a year in Florida, with the federal government
covering 55 percent, and serves about 3.2 million people. Childless
adults are generally not eligible but would be under the expansion.
All told, the expansion would add some 17 million people to the Medicaid
rolls nationally, including perhaps one million or more in Florida.
Under the law, the federal government would pay the full cost of each
state’s expansion for the first three years, starting in 2014, and
gradually decrease its share to 90 percent in 2020 and beyond. Last
week, Mr. Scott said in national television interviews that the state
would owe an additional $1.9 billion a year if, as the law calls for, it
expanded Medicaid to everyone with incomes up to 133 percent of the
poverty level. That is currently about $15,000 for a single person and
$31,000 for a family of four.
Mr. Scott has since backed off the $1.9 billion estimate; his spokesman,
Lane Wright, said he had based it on an outdated report. But the state
is still anticipating high costs, partly because it expects that a
number of people who are currently eligible for Medicaid but have not
signed up will do so, a concern shared by other states. The federal
government would pay a lower share of the cost for that group.
This article has been revised to reflect the following correction:
Correction: July 12, 2012
Because of an editing error, an earlier version of this article contained a headline, appearing on the home page of NYTimes.com, that indicated that states could opt out of an expansion of Medicare. The program being expanded is Medicaid.
Correction: July 12, 2012
Because of an editing error, an earlier version of this article contained a headline, appearing on the home page of NYTimes.com, that indicated that states could opt out of an expansion of Medicare. The program being expanded is Medicaid.
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