A Republican governor, the Medicaid expansion, and the “conscience” of health care

From the Miami Herald a few days ago, Florida Gov. Rick Scott supports Medicaid expansion:

Gov. Rick Scott said Wednesday he supports expanding Medicaid and funneling billions of federal dollars to Florida, a significant policy reversal that could bring health care coverage to 1 million additional Floridians.

“While the federal government is committed to pay 100 percent of the cost, I cannot, in good conscience, deny Floridians the needed access to health care,” Scott said at a hastily called news conference at the Governor’s Mansion.

Scott, a former hospital executive, spoke with unusual directness about helping the “poorest and weakest” Floridians — a stunning about-face for a small-government Republican who was one of the loudest voices in an aggressive, and ultimately successful, legal strategy to kill a law he derided as “Obamacare.”

Later in the piece, right at the end actually, comes this bit of background on Scott’s decision: “Part of his self-described ‘new perspective’ came from the death of his mother Esther last year, he said.”

There’s a little hedging in Scott’s use of the clause “While the federal government is committed to pay 100 percent of the cost”, but this a major step by the governor of one of the nation’s most populous states.

It’s good news for the future of the Affordable Care Act, but it’s even better news for the large number of Floridians who would have fallen through the cracks if Medicaid was not expanded in the state. I laud Scott for letting his conscience lead him to the right decision. The American health care system as currently configured is a mess: we currently pay more per capita for health care than any of our major allies, but we have millions of uninsured and have measurably lousy health outcomes in key areas. We give extraordinary benefits to many over 65, but the broad middle class of workers are paying more and more for less and less.

The ACA will not solve all the problems we have — and it might even make a few problems worse, although the early signs look pretty good.

But the ACA is going to accomplish some of the things that matter most, like getting millions more Americans into affordable insurance plans and providing coverage through Medicaid for millions more lower-income Americans, the vast majority of whom are working, contributing members of society.

The simple fact that Georgians’ taxes are going to help that expansion in other states but not at home might eventually effect a change.

But I’m confident the moral case will become clearer and clearer.