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February 21, 2013 10:30 AM Why States Can’t Turn Down the Medicaid Expansion

By Aaron Carroll

I’ve said it before, and I’ll say it again. It will be hard for states to turn down the Medicaid expansion:


  1. This is a pretty good deal for states. They’re getting most of the tab picked up by the feds.

  2. It’s one thing to turn down high speed rail. It’s another to tell your constituents that they can’t have insurance entirely paid for by the federal government in 2014.

  3. As more and more states take the money, those that don’t will be more easily marginalized.

  4. History. States threatened not to join Medicaid the first time as well. All did, eventually. Now the program is so American that threatening to remove it is “coercive”.

  5. There will be enormous pressure from doctors, hospitals,pharma, etc. who potentially will lose a lot of money in uncompensated care. They have pretty good lobbying groups.


Florida just joined those states. Florida!

Hours after the federal government agreed to grant Florida a conditional waiver to privatize Medicaid statewide, Gov. Rick Scott appears ready to endorse a plan to conditionally expand the health care program to at least 1 million more Floridians.
Scott has hastily called a 5 p.m. news conference to make an announcement regarding Medicaid.

It’s hard to ignore the irony here. Florida is, after all, the state that brought the case to the Supreme Court (and won!) to avoid the “mandatory” expansion. Now, Gov. Scott seems to be accepting it.

The legislature still has to approve this deal, and that’s not assured. But with popular support in the state, and lobbying from various health care system groups, I think they’ll follow Scott’s lead.

More states will follow.

[Cross-posted at The Incidental Economist]

Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.
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Comments

  • Zachary Smith on February 21, 2013 7:50 PM:

    *** Hours after the federal government agreed to grant Florida a conditional waiver to privatize Medicaid statewide, Gov. Rick Scott appears ready to endorse a plan to conditionally expand the health care program to at least 1 million more Floridians. ***

    Am I being paranoid here, or is this simply another instance of BHO selling us out again by cutting a deal with one of the worst of the Tea Bagger Governors?

    http://www.motherjones.com/politics/2011/03/rick-scott-florida-medicaid-solantic

    That old article describes two effects of privatization: Rick Scott gets even richer, and elderly/poor Florida citizens get screwed even worse.

    IMO Scott has decided that backstabbing his Tea Bagger supporters is worthwhile if it pads his bank account with a few hundred million extra dollars. And BHO's motives? How many guesses do I get?

    What am I overlooking?

  • Crissa on February 21, 2013 8:12 PM:

    I think, Zachary, you're missing the part that Scott would be basically doing this anyhow.

    Obama is superfluous to the creep's scams.

  • Zachary Smith on February 21, 2013 9:49 PM:

    In that case I don't understand where that "conditional waiver to privatize" fits in. From the last link:

    The privatization expands on a five-county pilot program that has been rife with problems. Critics worry for-profit providers are scrimping on patient care and denying medical services to increase profits. Some doctors have dropped out of the pilot program, complaining of red tape and that the insurers deny the tests and medicine they prescribe. Patients have complained they struggled to get doctor's appointments.

    Several health plans also dropped out of the pilot program, saying they couldn't make enough money. Patients complained they were bounced from plan to plan with lapses in care. Nearly half of the 200,000 patients enrolled in the pilot have been dropped from at least one plan, federal health officials noted at one point during negotiations.

    It seems to me somebody rewarded failure and folded like a wet noodle to the skin-headed Tea Bagger. If not BHO, then who?