Medicaid expansion: Is Florida's Gov. Scott the new compassionate conservative?

Florida’s Gov. Rick Scott, formerly a critic of President Obama’s Affordable Care Act, is not as rigid in his opposition as he once was.

“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Scott said at a recent news conference.

“We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time,” Scott said, according to the New York Times.

Is Scott ushering in a new era of compassionate conservatism?

The term “compassionate conservatism” is a political philosophy accredited to Doug Wead, a US historian and politician in a speech in 1979. Both Democrats and Republicans, including the former US President George W. Bush. Even British Prime Minister David Cameron has espoused the philosophy.

The Florida governor now joins the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio in deciding to join the Medicaid expansion. Some, like Gov. Jan Brewer of Arizona who were also staunch opponents of Obama’s health care law, have decided to be compassionate to the poor and handicapped.

The Florida governor’s move, however, is not swaying some other Republican governors. The GOP governors of Texas and Virginia emphatically said they're not Rick Scott or any of the other Republican governors, according to a Huffington Post report.

Scott's decision to broaden Medicaid to anyone who earns up to 133 percent of the federal poverty level, which is $15,282 for a single person this year, must pass the Florida legislature.

While Scott’s support of Medicaid expansion is significant, the Republican-dominated Florida legislature is not supportive of Medicaid expansion under the Affordable Care Act and must gain support through its own committee process.

The legislature’s two top Republican leaders have already said that before making a decision they would consider recommendations from a select committee, which has been asked to review the state’s options.

“The Florida Legislature will make the ultimate decision,” Will Weatherford, the state House speaker cautioned. “I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability,” he said in the New York Times.

Medicaid covers three million people in Florida and costs the state $21 billion a year. The expansion would extend coverage to one million more people. Scott has said he approves of the expansion as long as the conditions stated in the Affordable Care Act will fund the expansion 100 percent. The ACA ensures 90-100 percent funding to the states.

States that take up the Medicaid expansion will not incur more than 10 percent of the cost of covering new beneficiaries and will enjoy the added benefit of federal money that creates jobs and increases consumer spending, thereby spurring local economies by the “multiplier effect” of federal funding.

Compassionate Conservatives

In 1992, Newt Gingrich distributed Marvin Olasky’s now famous book “The Tragedy of American Compassion” to the representatives of the 104th Congress in an effort to characterize the Congress as welcoming a new era of compassionate conservatism. In the book Olasky argues against government programs and suggests that private charity has the power to change American lives.

In 2008, former Arkansas governor Mike Huckabee put in an unsuccessful bid for the GOP nomination for president as a compassionate conservative. He supported tuition breaks for the children of illegal immigrants in his state, saying that "You don't punish a child because a parent committed a crime." Huckabee said he was a conservative, just not angry about it, in USA Today.

In the last election some supporters, still believing the Tea Party held sway in the elections, vied to take the hardest line in opposing government-funded programs to help the poor, with Newt Gingrich calling Barack Obama a "food stamp president" and Rick Perry blasting "this big-government binge [that] began under the administration of George W. Bush."

With the emergence of the Tea Party in 2009, compassionate conservatives became extinct in Washington, D.C., and since the Great Recession, social benevolence has been hard to find, particularly among Republican politicians.

Economic benefits for states expanding Medicaid

Despite the belief that cuts in spending are anathema to Democrats, federal payments are being reduced to hospitals under the ACA, but with the caveat that states’ expansion of Medicaid will reduce the high volume of the uninsured presenting at hospital emergency rooms; therefore, uncompensated care cost shifted to the privately insured would decrease and ultimately reduce the cost of health care delivery systems.

Without Medicaid expansion, small rural hospitals might be forced to close because they will not be able to offset uncompensated care costs. Their closures would leave entire communities without access to hospital care. An additional hardship would be the loss of many jobs, which small communities cannot afford to lose.

Compassion has not been a term used for a long time in Washington. But with some states now realizing that the Affordable Care Act was designed to help the poor and the middle class in their states while keeping and creating jobs, Republicans might be revitalizing compassionate conservatism—at least when the health of their states’ citizens is put before party politics.

Resources

http://www.huffingtonpost.com/jeffrey-young/medicaid-expansion-in-flo_b_2733355.html

http://en.wikipedia.org/wiki/Compassionate_conservatism

http://usatoday30.usatoday.com/news/opinion/forum/story/2012-01-29/compassionate-conservatism-bush-santorum-republican/52873150/1

http://www.nytimes.com/2013/02/21/us/in-reversal-florida-says-it-will-expand-medicaid-program.html?_r=0

http://www.law.harvard.edu/academics/clinical/lsc/documents/CHLPI%20advocate%20tool%20state%20stances%20on%20Medicaid2.pdf