What the Rick Scott Decision Says About the Future of Health Care in the U.S.

In 2009, Rick Scott founded Conservatives for Patients’ Rights, a health care pressure group opposed to President Obama’s health reforms.

In 2010, Scott ran for governor of Florida on a mission to repeal Obamacare.

In 2012, Scott … will work to implement Obamacare.

For some conservatives, it’s a shocking reversal. Leaders of Americans for Prosperity, the conservative organization backed by the influential Koch brothers, were publicly disappointed in the Florida governor — who not so long ago said the Affordable Care Act was “the biggest job killer in the history of the country.”

Now, it will be Scott’s job to help implement it.

Changing Tune

Given his prominence, Scott’s move from Obamacare opponent to grudging supporter may be the biggest symbolic shift on the law since its passage.

The Florida governor was reportedly pressured by state legislators to negotiate with federal officials over the ACA, once November’s election made clear that Obamacare was here to stay.

But Scott won’t be the last GOP official to change his tune. More health care groups in other Republican-led states are putting similar pressure on their leaders to opt into the ACA’s Medicaid expansion, in hopes of securing additional dollars for providers.

And some prominent conservative thinkers are shifting their stance, too.

“Opposing Obamacare is no longer enough,” according to Avik Roy — a former Romney-Ryan campaign adviser and prominent ACA critic — who weighed in at National Review.

“We will have to accept that repealing Obamacare is no longer possible, and instead step back and look at the health-care system as a whole and ask: If we were designing a health-reform agenda from scratch, what would it look like?” Roy wrote.

Ongoing Criticism of Medicaid

Many of those reform principles still center around Medicaid, and whether it’s possible to transform how the program is funded and works with the states.

Some argue that those changes aren’t just necessary — they’re overdue.

“We believe that significant, fundamental reform to save, strengthen and secure Medicare and Medicaid are imperative,” Rep. Tom Price (R-Ga.) told The Hill this week.

A number of Republicans say that they still favor House Budget Committee Chair Paul Ryan’s proposal to block-grant the Medicaid program in hopes of slowing spending. That plan is expected to come up in congressional debate over a deficit deal this winter, although it is extremely unlikely to be adopted, given Democrats’ control of the Senate and the White House’s desire to protect Medicaid funding as a key part of the ACA.

However, Ryan’s aggressive reforms may allow GOP negotiators to “set the goalposts” and try to win some lesser compromise, one Capitol Hill health staffer told California Healthline. For example, Republicans are expected to push for concessions on the pace and size of the ACA’s Medicaid expansion.

GAO Affirms Medicaid Quality of Care

But Republicans arguing to scale back the Medicaid expansion may have lost one of their key attack lines this month.

One of the major conservative criticisms against Medicaid is that the program is poorly funded and leads to substandard care — in some worst-case scenarios, critics charge, obtaining Medicaid coverage creates more access problems for patients than being uninsured.

“The academic literature has consistently illustrated that Medicaid patients have poorer access to care, and poorer health outcomes, than privately insured patients,” according to a Heritage Foundation research brief.

But that’s not the case at all, according to a recent report by the Government Accountability Office.

While Medicaid reimburses physicians at a lower rate than private insurance, beneficiaries’ access to medical care is comparable to individuals with private insurance, the GAO concluded.

That finding reinforces what researchers like Harold Pollack and Aaron Carroll have long argued: Medicaid’s benefits are too often overlooked and the program’s quality of care is drastically misreported.

New Analysis Will Be at Center of Lobbying

Meanwhile, another new study has moved to center stage of the policy debate this week: a report released by the Kaiser Family Foundation and conducted by researchers from the Urban Institute on states’ costs and benefits from adopting the Medicaid expansion.

The researchers found that states will have to spend millions more on Medicaid over the next decade regardless of whether they join the ACA expansion — but states could reap billions in additional federal dollars if they choose to participate.

Those findings already are influencing debate over state participation in the program. For example, Alaska health care advocates are using the KFF/Urban analysis to lobby Gov. Sean Parnell in hopes of convincing the Republican governor to opt into the ACA’s Medicaid expansion. According to KFF/Urban, if Alaska joins the Medicaid expansion and lays out an additional $147 million across a decade, it will receive another $1.5 billion in federal funds for the program.

Yet liberals’ overwhelming support for state Medicaid expansion, amid Washington’s persistent deficits, raises the question: Where will these Medicaid dollars come from, the Atlanta Journal-Constitution’s Kyle Wingfield writes.

“Why is it that none of the ‘found money’ advocates ever explain how we’re going to pay for this new spending?” Wingfield asks.

“Or do they think … taxpayers will truly believe someone else will handle that federal portion of the cost?”

Dan Diamond (@ddiamond) is Managing Editor of the Daily Briefing, a CaliforniaHealthline columnist, and a Forbes contributor. This post originally appeared at CaliforniaHealthline.org.

12 replies »

  1. Just having a little fun at your expense Steve, But you’re correct, we can do better… and I apologize for being so obtuse.

    However, I worked for HCA in the 90’s, and there is a reason things ended for Rick the way they did, but it had nothing to do with criminal activity. I was there… But Steve, “ad hominem”, Rick Scott a criminal? really??

    Sir, where is your compassion. It’s hard for some people to have sympathy for anyone who is given $200M to go away, but with driven individuals like the Gov, that money meant nothing.

    If you want to know what happened I’ll sincerely explain it to you from my perspective. But Rick is no criminal. His flaws got out in front of him during that time, and I’m sure if given the chance he would do things vastly different.

    We are in total agreement on one thing, this storm has been brewing for decades. In my opinion, since Truman signed into law the Hill-Burton act in 1946. It was a well-intentioned, and needed, law for that time, but over 60 years things have gone terribly wrong. The GOP is utterly clueless and way over their heads. The Progressives are taking political advantage of the situation.

    I have proposed a simple solution to the healthcare dilemma and I’m doing everything possible with the limited resources at my disposal.

    Strip away my insults to your intelligence, and your indictment of the Gov., what is your solution? Respectfully, have you identified the root problem to be corrected?

  2. An ad hominem followed by standard right wing thoughts. We can do better. Come back when you want to get serious. This has been a problem building for decades and neither GOP nor Democratic governors have been addressing it. Placing known criminals in a position to solve our problems is not our solution. OTH, IT companies have hired known hackers to help with their security problems. Maybe Scott is the right guy.


  3. Steve your knowledge of healthcare is probably as in-depth as your eloquent informed comments.

    There is an old saying that even you might understand. “He didn’t stop shooting, he’s reloading”

    While Gov. Scott sifts through this Obamacare garbage and attempts to make the best of a bad situation, he will no doubt be prepared for whatever contingency to implement a more equitable solution for our States health care system.

    So go back to your six-pack and slim-jims and keep watching your bugs bunny and msnbc.

    Don’t worry Steve, there are adults that will solve this. While your ability to understand anything more in-depth than whats printed on a bumper stickers, I hope someone can read the following for you and possibly draw you a picture so you can understand.

    Gov. Scott is uniquely qualified to address the hospital “for profit”/ “not for profit” problem at the heart of all our health care issues.

    Steve, you’re probably doing well to change the propane tank on your trailer home. And until you learn it is a reverse thread setup, you’re going to keep stripping out your regulator fittings.

    Here is the solution for health care system reform…

    1. Reduce the Federal government role of Medicare and Medicaid administration to a guideline/oversight role for State administered Medicare and Medicaid programs.

    2. State collect and retain all current Medicare/Medicaid payroll withholding revenue.

    3. State collect and retain corporate income taxes, State sales taxes, and property taxes, from health care facilities and providers, for State Medicare and Medicaid program funding. Exempt providers from Federal corporate income tax collection.

    4. State regulate profits, investment, and taxation of all hospital facilities receiving Medicare/Medicaid and insurance payments, utilizing a similar model of investment, regulation, and taxation of the publicly held utility industry i.e. power, gas, et al.

    5. Eliminate 501(c)(3) status of all primary care facilities that receive Medicare, Medicaid, and Insurance reimbursements. Standardize accounting and securities exchange reporting for all hospitals. Structure IPO issuance for publically held portions of health care facilities i.e. Hill-Burton, municipality, community, university et al.

    6. Hospitals constructed and operated by charitable and religious organizations that receive Medicare, Medicaid, and insurance payments must go public with an IPO. The current charitable benefit organization may retain corporate interest, however, all “benefit to the community” programs must be funded from that charitable benefit’s portion of the profits after State taxes.

    7. Restructure health care philanthropic efforts to strengthen charitable benefit organizations. Properly incentivize individuals and groups with appropriate federal tax deductions that support programs for the disadvantaged and needy. Providers that operate solely on charitable donations, that do not accept Medicare/Medicaid and insurance payments, will remain eligible to retain 501(c)(3) status.

    8. “Means Test” individuals seeking Medicare and Medicaid program coverage. Expand Medicaid to include the working poor and uninsured due to preexisting conditions. Individuals with sufficient means or exhibit low risk for indemnity loss will be given the option to be placed in appropriate state “risk pools” or self-pay for services.

    9. Establish State subsidized and tiered insurable “risk pools” for individuals desiring to transition away from the State run Medicaid programs. Structure “risk pools” to transition individuals with means away from State run Medicaid programs to more favorable group rate policies, allowing private companies to bid for the various pools.

    10. Require hospitals and all care providers to provide “up front” estimates for all basic services such as consultation, diagnostics, and treatment options, prior to service delivery or payment. Consumers must be empowered to competitively shop for services that meet the individual consumers standards balancing quality, price, and coverage limits. Providers are entitled to charge whatever is appropriate for their level of service delivered however, providers must charge the same price regardless of the method of payment.

    With this plan we can properly fund Medicare and Medicaid programs at 100%, while expanding Medicaid to include the working poor and those with pre-existing conditions.

    Consequently it will begin to drive the price for health care services down, and provide true GDP growth to our economy.

    “Health care isn’t a problem… it’s the solution….

    We have an opportunity to turn our biggest liability into our greaest assets. It’s going to be up the Republican Governors and Congress to sort this out… They are our last line of defense, and our window of opportunity is narrow. God help this country…


  4. i have read it completely and found it that scott is right and agree with his information and appreciate researchers found that states will have to spend millions more on Medicaid over the next decade regardless of whether they join the ACA expansion

  5. Al, I have no doubt that is correct, but ideology so permeates the Republican party that I am skeptical they can accept this reality. You don’t simultaneously understand that Medicaid is a cost-effective way to expand coverage and say the ACA will destroy the economy, which is what Scott did. Yes, I know, he could have been lying earlier, but it’s either that or he has a different game now. Republican ideology suggests that his game now is not to expand meaningful coverage in the most effective way, since he doesn’t believe government programs could do that.

    I think Spike’s point may be the most insightful. Scott is simply being pushed politically and by the economics of getting federal money flowing to the state. And if his previous delays mean FL misses deadlines and struggles, why just blame the law and pretend the obstruction never happened.

  6. My two cents worth would be that Medicaid is shockingly efficient (mostly by holding down provider reimbursement to levels that are maybe only 50% higher than doctors in most other countries would accept), and that in many (not all) states access is no longer a major issue.

    You could do a lot worse than expand the Medicaid roles to get more people insured in a cost-effective way.

  7. Don’t forget the law suits between the counties of Florida and the state of Florida over reimbursement for the uninsured. Expanding Medicaid makes a very nasty problem disappear. The counties forcing the states’ hands will be a major factor as red states choose to expand.

  8. If Scott is doing this, we should expect that he has found a way to make money off of it. The guy is a crook of the highest order. Should be in jail and not the governor’s chair.


  9. Hmmm ….

    As the guy behind HCA, Scott knows his stuff pretty well.

    And he’s a smart guy with extremely smart guys working for him, no matter what you think about his politics or personal style.

    I think this is a case of scoring political points – whacking Obama repeatedly over the head for the benefit of voters – while preparing behind the scenes at the same time. Classic stuff.

    Don’t forget that he made his money by figuring out the interplay between Medicare and the provider and working the system to his advantage …

    Jonathan may be right, but note that Florida was one of the few states to move forward with plans to develop its own exchange ahead of the election – although it is not clear exactly what that means ..

    Smart observers will do well to study the game in Florida and take note …

  10. Two questions:

    1) Why do we have reason to believe Rick Scott isn’t Lucy holding the football for Charlie Brown? He says he won’t obstruct implementation, but Florida is way behind and will have a hard time meeting deadlines, and if it does run into trouble, he could say “It’s not my fault, I’m trying to make this work, they just didn’t give us enough time/write a good law.” He couldn’t credibly blame the law for problems of implementation if he was (seen to be) obstructing it.

    2) Why are we asking about sources of funding in late 2012, as though it were a mystery, when this was discussed at great length in 2009/10 and is written explicitly into the law? You can disagree about how much money will be raised, or dislike those parts of the law, but funding was not ignored.

  11. Re Rick Scott, it’s really no surprise that he’s getting on board. Watching the movie Lincoln, I got a real sense of the amount of horse trading and management of the end vs the means compromises that politicians make.

    Whether one takes the altruistic view of people (rivals eventually get on board with the plan because fundamentally, they want to serve the greater good of people and want to help move the ship forward in one direction) or the more cynical view (the losers of a major policy or business decision realize they had better get on board with the winning side or risk an even weaker position), politicians and other rivals often do cross over.

    The bigger questions are the one raised in the end of the article – where is this money going to come from and will higher taxes on business and the wealthy cause a negative impact to the growth of jobs? And, will the cost for medicaid expansion be born by all states anyway, so it only makes sense to get on board with the ACA? States that can absorb the cost may choose to take a pass but they will certainly be the exception.