Florida governor Rick Scott was one of the new federal health care law's most strident opponents, leading the charge to sue over the law and repeatedly warning of the dangers of expanded coverage. Yesterday that all changed and Scott became the seventh GOP governor in the nation accepting federal money for the Affordable Care Act's expansion of Medicaid health coverage to low income people, saying:
“I cannot, in good conscience, deny Floridians access to health care."
In North Carolina we are a very, very small legislative step from going in the opposite direction. Both the NC House and NC Senate have passed a bill blocking North Carolina from accepting federal money to fund any Medicaid expansion. That bill is currently in a conference committee to work out minor differences between the two chambers. Governor Pat McCrory has indicated he too opposes accepting federal money for Medicaid expansion and will sign the bill.
But GOP governor Scott's decision yesterday sends up a flare that the GOP in North Carolina cannot easily ignore.
While the Florida legislature still must agree with the Governor Scott's plans, having the most populous state in the South accept expansion further isolates North Carolina and makes GOP arguments questioning the federal financial commitment to the Medicaid expansion look even more hollow. Indeed, NC Representative Farmer-Butterfield (D-Pitt, Wilson) proposed an amendment to the no-Medicaid bill in the House that would have used the federal money available for expanding coverage under Medicaid for three years with a reassessment at the end of that time - exactly what Governor Scott has proposed for Florida. Farmer-Butterfield's amendment, rejected on party lines, may be a now be a compromise NC GOP members wish they had taken more seriously.
Virginia's leadership is not united in its opposition to rejecting the federal Medicaid money, this wavering putting the NC GOP potentially at odds with friends both north and south.
For NC Governor Pat McCrory, Governor Scott's change of heart on Medicaid puts him in an extremely uncomfortable position. With this week's State of the State address and yesterday's quick trip to Clayton for an afternoon hot dog with "the people" after his country club lunch, McCrory is clearly still trying to cling to the label of moderate Republican Charlotte mayor, despite signing (away from the prying eyes of the press) the largest cut of unemployment benefits in the nation this week. However, blocking the billions in federal money available under the new health care law for making coverage available to hundreds of thousands of North Carolinians will be an act not so easily finessed as "moderate" when fellow GOP governors all over the country, including now in the South, are moving in the opposite direction.
By any measure, the Medicaid decision is shaping up to be a truly defining one for Pat McCrory. A choice this important isn't one he perhaps expected so early in his term but circumstances have changed and the rush of events is now overtaking the new GOP Governor. Should he choose to reject the federal money and block coverage, this issue will loom very large for the next year and beyond. January 1, 2014 is the date that lower income people in states around the country will be able to sign up for Medicaid. On that day if North Carolinians look around and see that people in Florida, Virginia, Ohio, and most other states in the country can get health coverage while that option is denied to them in North Carolina, many will look to the Governor's continued opposition, inaction, and lack of leadership on this issue as a stunning failure. And that failure will be repeated every day and with every story of families continuing to be unable to afford care they need - this time not through lack of national health reform, but only because they live in North Carolina.
Pat McCrory's failure will also be compounded by the General Assembly's hasty action to block Medicaid expansion. Right now the every Republican in the North Carolina General Assembly (and not one Democrat) is on record as voting to reject the federal money available for expanding coverage. Voters who see a very different picture of who can afford health coverage in most other states ten months from now may not be so willing to forgive this public rejection of federal help with expanding coverage.
In the end, Governor Scott's acceptance of the federal Medicaid money is a turning point in the implementation of the new health care law. Most states will move forward with the major aspects of the law, including the important extension of coverage to low-income people. States that continue to reject federal funding to expand coverage will become more politically and economically isolated from the rest of the country. And political leaders in states that still have to make a decision have to face the reality that opposition to accepting federal money to extend health coverage is an increasingly unpopular choice.