Political Animal


July 02, 2012 9:16 AM Scott and Jindal Go Over the Brink on Medicaid Expansion

By Ed Kilgore

In the continuing campaign for the mantle of America’s Worst Governor, Florida’s Rick Scott and Louisiana’s Bobby Jindal became the first of their peers to put aside coy equivocation and flatly say they would oppose implementation of the Affordable Care Act’s Medicaid expansion provisions.

A statement on Scott’s official web page indicates that Florida just can’t afford the deal that health experts have almost universally called “impossible to turn down:”

[E]ven though the federal government has promised to initially pay 100% of the increase in Medicaid payments for the first three years of ObamaCare, the burden increasingly shifts to Florida taxpayers in future years.

Yeah, all the way to 10% of the costs. What a back-breaker! Where would a guy like Scott come up with money for corporate “economic development” subsidies and private-school vouchers?

Meanwhile, Bobby Jindal went over the brink on “Meet the Press” yesterday:

Every governor’s got two critical decisions to make….One is do we set up these exchanges. And, secondly, do we expand Medicaid. And, no, in Louisiana, we’re not doing either one of those things.

The reality is that pols like Scott and Jindal are using the supposed fiscal burden of the Medicaid expansion—or of any move towards covering the uninsured—as a fig leaf for their ideological opposition to the very idea. If the feds were offering to pay 100% of the cost, or 110% of the cost, the answer would be the same.

I know, I know, it’s widely thought to be incontrovertible that logic, pressure from providers, and the sheer idiocy of states with stingy Medicaid programs turning down a massive redistribution of resources in their favor, will all convince Republican governors to go along with the Medicaid expansion after they kick and scream for the benefit of “the base.” Perhaps that’s true, and that the rhetoric is the latter-day equivalent of the “massive resistance” southern lawmakers pledged to wage against the federally-imposed demise of Jim Crow.

But as the civil rights precedent showed, the competitive pressure of demagoguery is sometimes a lot more powerful than the “business logic” of going along with a more rational course of action. Now that Scott and Jindal have thrown down the gauntlet, can Nikki Haley or Scott Walker or Rick Perry or Sam Brownback be far behind?

This is of more than academic interest since the design of ACA really does depend on Medicaid expansion. In states where Medicaid fails to cover those under the federal poverty line, there are potentially millions of people who will not qualify for the subsidies available to higher-income families participating in the health exchanges.

So anyone who cares about covering the uninsured would be well advised not to count on hospital lobbyists to bring Republican state lawmakers to their senses.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • CharlieM on July 02, 2012 9:47 AM:

    You left out our distinguished GA Governor - the ethically challenged Nathan "Let's make a" Deal. He and that wretched GA Attorney General have already decided that, after having taken the foreclosure settlement money and used it for "economic development (i.e. more corporate tax breaks) rather than foreclosure relief, they're not going to implement the exchanges or expanded medicaid program. Perhaps they feel that, after having sliced unemployment eligibility by 40% and slashed food stamp programs similarly, there won't be anyone alive that will use the program.
    Though I'm still wondering how after giving that money to corporations (more "economic development") they expect those same dead people to buy that increase in goods and services all this new "economic developent" is to generate.
    As another blogger would say, they're evil AND stupid.

  • John on July 02, 2012 9:47 AM:

    There's obviously going to be a lot of this kind of posturing in the short run. After the 2012 election, that kind of posturing is going to be a lot less attractive.

    I think we'll have to wait and see.

  • c u n d gulag on July 02, 2012 9:48 AM:

    And as these feckin' idjit R Governors, out to stir-up their base, and keep those morons in perpetual tit-wringing and knicker-knotting mode, will undermine the ACA on a national level through Medicaid, and then, when the ACA plan is NOT fully funded, and costs rise, will point to that as another example of why 'big government doesn't work!'

    With all of those Conservative tit's in a perpetual uproar, and knickers-knotting so that the private parts are part of the knot, it'll be amazing if the rest of us don't drown in milk to the high-pitched sound of their castrati choir.

    Thank goodness we have "The Fourth Estate" to point out their hypocrisy, contradictions, evil, and lies!

    It's all yours, so, take it away, all you great "Fourth Estate" guys and gals!!!
    What's that sound I hear?

  • K Wilson on July 02, 2012 9:51 AM:

    Rational politicians would reconsider when the World Wide Widget Consortium considers opening a big plant in the state, but decides against it because the cost of insurance is higher and nobody wants to relocate there. Whether Mr Scott and Mr. Jindal are rational politicians is debatable. But even irrational politicians may reconsider when enough of their constituents realize that their brother in North Carolina now has insurance that covers his heart problems and his kid's asthma, and start to wonder why they don't.


  • bleh on July 02, 2012 10:04 AM:

    Well, the South is still squealing about being dragged into the latter half of the 20th century. It'll be a while before they make it into the 21st.

    I wouldn't count on the business community to have much impact. It hasn't helped with the show-us-your-papers laws in Arizona, Alabama, or Georgia. And yeah, insurance costs may be a little higher, but depressed wages, an absence of regulation, and the emasculation of the legal culture make up for it.

    The economic leaders of the South want a race-based oligarchy, like many Latin American countries were (or are), and like the South itself was for most of its history. As long as the (increasingly poorer) white middle class remains complicit, change will be very slow.

  • Diane Rodriguez on July 02, 2012 10:10 AM:

    John@9:47. Posturing indeed that's what the Republicans are most comfortable doing. Really, the only avenue open if you have no substance. Apparently, they have also decided to throw all their rotten eggs into the repeal ACA basket. Wait until the Federal gov't comes in to set up exchanges, Scott will be much more cooperative as his wealth is derived from that sector. They remind me of toddlers holding their breath and stomping their little feet.

  • stevio on July 02, 2012 10:10 AM:

    Stupid is as stupid does...F. Gump

  • T2 on July 02, 2012 10:14 AM:

    "bring Republican state lawmakers to their senses" tempted to ask Ed what planet he lives on....but its too early in the week to be mean. So I'll say that GOP lawmakers will not return to sensible government, they cannot. They will not. They will obstruct everything that the Obama Administration proposes because that is their job. If the result is less than satisfactory for the people the represent....tough.

  • Basilisc on July 02, 2012 10:20 AM:

    Huge, huge opportunity here for Democratic governor candidates in states like LA and FL. All you have to do is promise to expand Medicaid and reduce medical costs, without raising taxes or cutting other spending. Hospitals will save hugely on ER right away, while over the medium term the health care system (and govt expenses on health care) will benefit from patients seeking treatment earlier.

    And the best part is, thanks to ACA, an incoming Dem governor can deliver on these promises, virtually from day one.

    It's almost as if it were all a clever political ploy by the Obama admin to get Democratic governors elected.

    Assuming, of course (always a big assumption) that Dems are smart enough to seize the opportunity.

  • c u n d gulag on July 02, 2012 10:28 AM:

    Don't bet the house on 'em...

  • dricey on July 02, 2012 10:37 AM:

    @T2: "Less than satisfactory for their people"? The people who elect these clowns couldn't care less about anything except getting That Alien out of their White House and sticking it to all those pointy-headed college-educated smarty pants intellectuals. They don't want better benefits: They want everybody else to have benefits as crappy or non-existent as their own. They don't want better wages: They want everybody else to be as dirt-poor as they are. And Ignorance is their religion.

    It's hard to believe that mass psychosis like this exists, but the evidence is all around us, isn't it?

  • Mimikatz on July 02, 2012 10:39 AM:

    They are all counting on Obama losing, and thus never having to implement the law because the new R Congress will repeal it. If by some miracle Obama does win, they can recalibrate their strategy to prevent a "federal takeover" through the exchanges. The Obama Admin would be very accommodative. Nothing matters until November 7, it is a free ride for em until then.

  • danimal on July 02, 2012 10:45 AM:

    "So anyone who cares about covering the uninsured would be well advised not to count on hospital lobbyists to bring Republican state lawmakers to their senses."

    So anyone who cares about electing Democrats has a pretty obvious deep-pocketed source of campaign dollars if they play their cards right. If this scenario plays out, doctors, hospitals, insurance companies and the businesses that support them will see profit opportunities when the recalcitrant GOP governors are shown the door.

    At the end of the day, I don't really believe Jindal, Scott and the others will pass up the Medicaid dollars, but if they do, it will bite them in the rear-end.

  • David Martin on July 02, 2012 11:21 AM:

    Here's Florida governor Rick Scott's press release. It manages to claim that Florida's existing programs are better than anything the Affordable Care Act would provide.

  • ComradeAnon on July 02, 2012 11:26 AM:

    Scott will come around. All that potential money he could obtain via fraud or his, I mean, his wife's clinics.

  • 2Manchu on July 02, 2012 12:16 PM:

    "Where would a guy like Scott come up with money for corporate 'economic development' subsidies and private-school vouchers?"

    Don't forget drug tests for welfare recipients.

    And voter purging! Don't forget voter purging.

    It takes a lot of money to drag your state down to Third World status.

  • Joe Friday on July 02, 2012 12:20 PM:

    There's a new wrinkle to this issue.

    Some of the HOSPITALS in the states where the governors are threatening not to accept the Medicaid expansion are saying that they will be unable to afford the uncompensated care for all the new people that will be eligible, and THEY MAY HAVE TO CLOSE THE HOSPITALS.

    Now how's that gonna sound to these communities, when they announce they will have to CLOSE HOSPITALS because [INSERT CRAZY REPUBLICAN GOVERNOR] is refusing to accept FREE federal Medicaid money ?

  • Rick B on July 02, 2012 12:36 PM:

    I really hope the Democratic Party takes after these governors in the election this fall on the health care issue. It won't lose seats in 2012 and it might win some, but it'll set the 2014 election up for a populist uprising against the conservatives all across the South.

    Short term panic by squishy Dems will probably keep that from happening. The Dem politicians are chicken little cowards and the Rep politicians are nasty self-centered unthinking bullies. Not a great choice.

  • DRF on July 02, 2012 12:41 PM:

    Apropos of Joe Friday's comment, if it is true that at most the states' cost for the expanded Medicaid is 10% of the total, this should be a deal that's too good to pass up. At a cost of 10% contribution, the state will see an increase in health care spending in their state, which generates additional business, greater employment and ultimately additional tax revenue for the state.

  • martin on July 02, 2012 1:45 PM:

    Perhaps that’s true, and that the rhetoric is the latter-day equivalent of the “massive resistance” southern lawmakers pledged to wage against the federally-imposed demise of Jim Crow.

    Just a reminder, many of them DID massively resist. They shut down the public schools in VA, parks and zoos and libraries were closed in the finest cut off your nose to spite your face behavior. It took decades to restore some of the damage. Some hasn't been restored.

    Don't put it past any of these reactionaries to try to outlast the Feds at the name of "Freedom" for their constituencies.

  • cwolf on July 02, 2012 2:35 PM:

    "...Florida’s Rick Scott and Louisiana’s Bobby Jindal became the first of their peers..."

    So what? Really.
    Scott's already a lame duck & all governors (and legislatures) are replaced eventually.

    It took many years for all the states to sign up for Medicaid and none seem eager to jump off. Even the criminally insane Scott hasn't gone there, yet.

  • jsjiowa on July 02, 2012 5:13 PM:

    Iowa's Governor is also resisting any implementation of the ACA, in spite of a state Senator who notes that, because Iowa already covers some of the people that would be covered by the Medicaid expansion, it would actually save the state money ($50 million, estimated) to opt in to the Medicaid expansion.


    What concerns me more is the prospect that if the feds set up the exchange for the state, the subsidies may not be available (due to a drafting error in the ACA). So people will have to buy unsubsidized insurance or be liable for the penalty (unless they qualify for a hardship exemption). That doesn't seem to be a decision made with the best interests of the state's citizens in mind...


  • Doug on July 02, 2012 5:33 PM:

    I think comparing the implementation of the ACA/Medicaid expansion with how some states opposed Him Crow laws overlooks one major point - voters. Most of those affected by Jim Crow laws couldn't vote; most of those affected by the ACA/Medicaid expansion CAN.
    Right now, anyway...