Florida Governor Rick Scott announced today that he thinks Florida should participate in the Affordable Care Act Medicaid expansion. This is a big deal because Scott is very conservative and health care is his signature issue and most liberals regard him as among the very most loathesome GOP governors and because it’s become a politically controversial issue in Republican circles.
All that said, this is a simple issue on the merits and Scott is dead right. The way the Medicaid expansion works is that the federal government will foot over 90 percent of the tab for states that cover more patients. Meanwhile, residents of states that don’t expand Medicaid don’t gain any special exemption from the taxes that fund the program. So even if you think the expansion is deeply unwise, it’s a simple collective action issue. Perhaps all states declining to expand would be better than no states declining to expand, but if some states expand and others don’t you clearly want to be among the expanders. Scott, whatever else you may say about him, knows a lot about the health care industry and the money to be made in it and (rightly) thinks it would be absurd to cut Florida patients and health care providers off from these opportunities.