Florida’s Rick Scott this week became the seventh Republican governor to embrace a key element of the federal health overhaul by enrolling more poor people in Medicaid. Don’t expect Gov. Nathan Deal to make it eight any time soon.
Deal, also a Republican, has remained outspoken in his refusal to expand Medicaid coverage to at least 650,000 more Georgians, citing the budget woes already facing the government health program. He said the state’s share of the cost of expanding Medicaid - a projected $4.5 billion over a decade - would be too great.
“My position hasn’t changed,” Deal said Thursday. “Our financial situation hasn’t changed either. It is on that basis that I made my judgment call.”
Still, he said, he’s interested in talking with Scott and other GOP governors about why they made their decisions.
“I think their situations of course are somewhat different than the ones here in Georgia,” he quickly added.
Deal, like many members of his party, favors converting Medicaid into a program that would dole out block grants to states. That money would come with fewer restrictions from the federal government, but it would also limit the amount of federal dollars states get to a lump sum.
The Obama administration and most Democrats oppose the idea, and critics say it could create a bigger budget hole long-term.
"It seems to be more of an excuse right now for states to say, 'If you don't do it our way, we're not going to do it,'" said Cindy Zeldin, executive director of the nonprofit advocacy group Georgians for a Healthy Future.
Scott joined the GOP governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio in bucking the party line by backing the Medicaid expansion. In all, 22 states and the District of Columbia have announced plans to broaden Medicaid. The expansion is a cornerstone of the Affordable Health Care Act’s effort to assure near universal coverage.
Scott’s decision puts Deal and others who railed against President Barack Obama’s health overhaul under more pressure. Florida, like Georgia, filed a legal challenge seeking to block the healthcare overhaul from taking effect. And Scott, like Deal, initially said his state wouldn’t expand Medicaid programs to cover the poor after the Supreme Court upheld the law last year.
The Florida governor’s about-face came after the Obama administration approved state-specific changes that give him more flexibility - and amid pressure from hospitals that want to cut down on uninsured patients. In a press conference on Wednesday, he argued he couldn’t “deny the uninsured access to care” when federal funding was assured for the first three years.
He also noted that Floridians will help pay for the federal expansion and said he didn’t think it fair to deprive his state’s residents of benefits. A November analysis projected that 1.3 million people in Florida would gain new benefits under the Medicaid expansion.
In Georgia, Medicaid currently covers 1.7 million low-income people, mostly pregnant women and children as well as the elderly and disabled. A recent Georgia State University study found that expanding the program would add 694,000 low-income people to the state’s Medicaid rolls over the next 10 years. The study said it would create 70,000 new jobs and boost the economy.
Supporters of the expansion, who have formed a coalition called Cover Georgia, argue the state is turning its back on an infusion of federal funds that will help states that are expanding. That could amount to $40 billion in Georgia over the next 10 years, though the state would take on a greater financial burden for the funding down the road.
“It’s inexcusable. It’s immoral. And the reason he won’t do it comes down to one word: Politics,” said Senate Minority Whip Vincent Fort, who carried with him a slip of paper scrawled with the names of Republican governors who have embraced the expansion.
“The far right in his party intensely hates the president. And the one thing they hate the most is the health care act.”
Tea Party leaders consider an expansion of Medicaid the equivalent of crossing a firm political boundary. Debbie Dooley, the Georgia Tea Party Patriots state coordinator, warned that Deal could face a challenger from the right if he “does something crazy like set up a healthcare exchange or expand Medicaid.”
Deal said Thursday there’s only one way to change his mind about expanding Medicaid.
“I don’t know of any outside factors other than maybe action at the federal level that would perhaps modify the status of the program in terms of federal contributions and guarantees,” he said. “Or if my suggestion were to hold true, some flexibility that would be in the form of block grants.”
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