Political Animal


February 21, 2013 9:07 AM Scott Flip-Flops On Medicaid

By Ed Kilgore

I mentioned yesterday that Florida Gov. Rick Scott, after years as a font of anti-Obamacare posturing, had suddenly gotten “cagey” about the fate of ACA’s Medicaid expansion. Later in the day, Scott held a hastily called press conference and announced that he was, indeed, going to support the expansion. Not coincidentally, the Obama administration announced at about the same time that it was granting Florida a waiver to expand a Medicaid managed care pilot program statewide.

While Scott mentioned the recent death of his mother as having changed his perspective on “big decisions,” and also said his support for the expansion would only extend (for now) to the three-year period where the feds will pick of 100% of the cost, his flip-flop is going to be widely intepreted as motivated by his interest in getting re-elected. That was certainly the take by RedState’s Erick Erickson, who called it “a sad day for conservatives.”

Americans for Prosperity took a slightly different route, calling on Florida’s Republican legislative leaders to buck Scott and reject the expansion. I can’t quite see them letting Rick Scott, of all people, triangulate them on an issue where Republicans generally are swimming upstream. But you never know with these birds.

The “privatization” deal Scott got from HHS is worth watching, since Florida’s management of a regional pilot project has been spotty to say the least. But nationally, the horse left the barn a long time ago on the general proposition of enrollment of Medicaid beneficiaries in private managed-care plans. As of 2010, an estimated 70% of those on Medicaid around the country were in such plans. And managed care companies have been prominent among those lobbying both Congress and the states for the Medicaid expansion.

Rick Scott has a long way to go before he’s a viable candidate for revelation. But about a million Floridians who will be covered by the Medicaid expansion (if it’s not torpedoed by the legislature) are happy to have been able to serve as props in his first dramatic step towards political recovery.

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.


  • Barbara on February 21, 2013 9:39 AM:

    It's worth mentioning that even states like California have the majority of Medicaid beneficiaries enrolled through managed care programs. Because Medicaid beneficiaries often have an especially difficult time locating providers (and not just because the providers aren't paid as well), HMOs, etc. can improve access and facilitate better care. It all depends on what the alternative would be, and just having Medicaid coverage is not always enough to ensure access. Most of the non-managed care population are those who are elderly and also covered by Medicare, as well as those living in rural communities where it's hard to implement managed care plans.

    But seriously, this is really good news for residents of Florida, especially those who are uninsured.

  • biggerbox on February 21, 2013 10:10 AM:

    Well, it's good to know Scott values something. He was unwilling to say "no" to a deal which has the Feds write three years worth of checks to his friends in the managed-care business, gives him the ability to act like he cares a little about poor folk, and costs his state nothing. Erick son of Erick apparently forgot that Rick Scott was a health-care profiteer first and a politician second.

  • Josef K on February 21, 2013 10:10 AM:

    I'll echo the guarded relief already expressed, but have to also suggest an alternative: that Scott's 'flip-flop' is intended to fail.

    Let's be blunt: Florida Republicans tend towards "teh crazy" with a zeal rarely seen. If they can convince themselves that shunning even a limited expansion of Medicaid like this is both good and right (highly subjective terms both, I know), and if they're offended enough that Scott would be a willing party to it, they may just go ahead and return the favor towards him and reject the whole thing.

    Scott would be a clear winner in that case. He was willing to extend coverage to the uninsured, but was stopped by ideologues in the Statehouse. His stock goes up with the voters, looks more 'moderate' in the process, and possibly gets the federal government to step in to take up the slack.

    Maybe I'm giving him too much credit, but the last decade has kinda-sorta put paid to most of my illusions about the modern Republicans recognizing any limits to their politicking.

  • JohnMcC on February 21, 2013 10:26 AM:

    Mr Scott also pledged "an unprecedented flood of money" to port and roads (not toll-roads!) this week. Amazing how the prospect of being hanged in a fortnight concentrates the mind wonderfully - as Dr Johnson might have said.


  • DTR on February 21, 2013 10:35 AM:

    Scott's only concern has always been Scott. He sees benefit for him in widening the healthcare provider potential. After his gubernatorial defeat, back to providing shoddy medical care and participating in medicare/medical fraud. He's merely preparing a soft and profitable landing.

  • mudwall jackson on February 21, 2013 10:39 AM:

    josef k

    my guess is scott gets little credit for this politically if it goes down in flames in the legislature. and even if it goes through, he'll still be one of the most unpopular governors this state has seen in decades and perhaps ever. it will take more than this to repair his image. and while the legislature certainly has its share of lunatics and half-wits, and then some, i do think this goes through.

  • wvmcl on February 21, 2013 11:01 AM:

    Funny how righties never give a squat about anyone else until something happens in their own families (i.e. his mother's death). Are these people totally incapable of empathy?

  • esaud on February 21, 2013 11:48 AM:

    DTR has it right. Scott will profit handsomely off of this.