Medicaid expansion in Florida: A sweet deal for whom?

In a reversal of his longstanding contempt for and condemnation of the Affordable Care Act (ACA) known as Obamacare, Gov. Rick Scott endorsed Medicaid expansion. His hasty press conference came immediately on the heels of an announcement by the US Dept. of Health and Human Services that Florida could largely proceed with its scheme for privatizing Medicaid statewide.

Ah-ha! The fix was in, you think – a quid pro quo. The feds and the guv say, ‘No way.’ But you, smarty pants progressive, Daily Marion reader, “You’re right!” You have read our posts on this subject.

Following the Supreme Court decision on the ACA, it seemed to us like ideology would remain Scott’s guiding light, but then in considering the amount of money involved, it was recognized that billions of dollars can motivate remarkable turnarounds in attitude. While Scott is alienating his Tea Party base and other (former) allies by betraying them on Obamacare, he exposes himself to a challenger from – hold your breath – a worse conservative who will continue to demonize Obamacare. Still, the possibility of a quid pro quo seemed in the works to us:

Did Gov. Scott manage to pull a quid pro quo from HHS Secretary Kathleen Sibelius that will have Florida as more cooperative participant in the ACA Medicaid expansion in exchange for this scandalous profit-from-the-poor scheme?

A huge concern is oversight of this privatization scheme. Those are the details that should be of paramount concern. The feds need the ability to apply close scrutiny, intervene, and have the authority to cut off poor performers swiftly since dismal performance has plagued the pilot program in a variety of ways. In general, Florida has a terrible history of compliance with federal rules.

Florida CHAIN, a health care advocacy group, stated:

Consumer health advocates have fought hard to ensure that access to care and consumer protections remain a top priority. We are encouraged by the inclusion of those protections and the movement toward a more transparent, inclusive process and more robust independent monitoring. We are hopeful that the final language and implementation will reflect what is most important – full access to quality health care for Medicaid beneficiaries with proper oversight.

There has been an expected push back from the legislature since they don’t like it when governors act independently. House Speaker Will Weatherford (R-Wesley Chapel) released a statement:

“Governor Scott has made his decision and I certainly respect his thoughts. However, the Florida Legislature will make the ultimate decision,” state GOP House Speaker Will Weatherford said in a statement Wednesday. “I am personally skeptical that this inflexible law will improve the quality of healthcare in our state and ensure our long-term financial stability.”

Don’t think that the legislature is likely to torpedo this deal. This is just turf defense. They have all been waffling since the SCOTUS decision, and got really shaky-bakey when Romney lost. Prime legislative health care leader, Sen. Joe Negron (R-Stuart) said this week:

Sen. Joe Negron, R-Stuart, chairman of the Senate panel reviewing the law, told the Palm Beach Post there is “clearly a nexus between the two … Without the waiver, we are not likely to move ahead with expansion.”

How likely is the Senate (and the House for that matter) to move ahead with Medicaid expansion? With Gov. Scott taking the lead, and the heat, it opens doors for the GOP legislative leaders to kick a little dirt, look down, and admit the federals dollars will make their best-est friends, the medical and insurance lobbyists, really damn happy. Um, what ideology?

Scott lamely tried to conjure a fig leaf to cover himself; a three year test drive of Medicaid expansion. Right. Once you let it in, it will be as entrenched as Medicare.

Now it would be a pleasant surprise to see the GOP leaders doing a bona fide, come-to-Jesus, on their knees expression of compassion for the poor souls who have no health insurance, who have suffered, who have been in pain, and who even stood to lose their lives. So, maybe a bit more emotive than the Governor:

Scott … said that he still had questions about the health care law but called the three-year Medicaid expansion a “compassionate, common sense step forward.”

Gee, that’s “gushing” for Gov. Scott who was also quoted as saying:

“I cannot in good conscience deny Floridians [healthcare].”

Okay, that last one made Snow White awaken and Pinocchio blush. Scott’s medical history indicates he has never been plagued with “conscience,” certainly not a good one, and is highly unlikely to be afflicted by one now.

Seriously, you know what’s going to make this a no-brainer: b-b-billions! How much are we talking about? Well,

Families USA released a report that said making more lower-income Floridians eligible for health coverage under Medicaid will yield 71,300 new jobs and pump $8.9 billion more in economic activity into the state.

Lawmakers have been getting an earful, like from the hospitals. You can imagine all the lobbyists who have been pressing legislators to figure a way to say “yes” to Obamacare’s Medicaid expansion billions. The Florida Chamber is among those cheering Scott’s decision – here the Miami Herald has a nice compilation of the wide variety of reactions.

With HHS okaying a privatization scheme for Medicaid, it’s definitely a done deal, not “compassion” at all. Health insurers and HMOs will be scrapping for a piece of the multi-billion dollar pie and market share, instructing the legislators that they’ve purchased to simply set the table for their taking.

It’s a sweet deal, alright. First and foremost, about a million Floridians will finally be getting health care. For them, it’s the sweetest deal – a genuine life-saver.

No matter how predatory the health insurers are likely to be (and rest assured, some will be true to form), it will still be better than no health care for the uninsured, and there will be recourse. Expect some shaky years for starters, but honestly, a competitive private marketplace for Medicaid could force insurers to do the job right or lose the contract to a competitor. But it’s definitely a sweet deal for the Florida health care industry, too.

Will everyone be happy? Not the Tea Party. The rest? Well, they certainly won’t admit to happiness … on their way to the bank.