It seemed like a breakthrough moment. In late February, Florida Gov. Rick Scott (R), who had made hating "Obamacare" his raison d'etre, announced his support for the Medicaid expansion policy in the Affordable Care Act. The Republican governor said at the time, "I cannot, in good conscience, deny the uninsured access to care."
It was an open question whether Scott's principal concerns were with the uninsured or the state hospitals he's been friendly with in the past, it was nevertheless welcome news for health care advocates. Florida's governor, an unlikely ally, had cleared the way for bringing health care access to 1.3 million Americans, expanding the reach of Obamacare to new heights.
At least, we thought so at the time. What was unexpected was Rick Scott's own legislative allies ignoring the governor's wishes and punishing Florida on purpose.
Scott wouldn't be the one to "deny Floridians" a part of the health care law -- but the Florida legislature had other plans. Lawmakers adjourned Friday after passing a budget that does not include funding for a Medicaid expansion. Unless the Republican-controlled legislature comes back for a special session later this year -- which some Democrats are calling for -- Florida will not expand Medicaid in 2014.
In Florida, where one in five non-elderly residents lack insurance coverage, the consequences are especially large: An estimated 1.3 million Floridians were expected to gain coverage through the Medicaid expansion. About a quarter of those people -- Floridians earning between 100 and 133 percent of the Federal Poverty Line -- would still be eligible for tax subsidies on the health insurance exchange.
As we talked about in March, Scott isn't the only Republican governor in this boat. In Ohio and Arizona, GOP state lawmakers remain reluctant to accept Medicaid expansion, regardless of its benefits, and regardless of the wishes of their Republican partner in the governor's office.
But the move in Florida is especially jarring given the circumstances -- the state has an enormous Medicaid-eligible population, and was poised to receive $66 billion in federal funds over the next decade. What's more, Florida already has struggling public hospitals, which will now be in even worse shape.
A Democratic state senator called the Medicaid decision "unconscionable," which is true, but apparently irrelevant to state GOP lawmakers.