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Outrage of the Month: Republican Politics, Medicaid Expansion and Hypocrisy

Health Letter, April 2013

By Sidney M. Wolfe, M.D.


If you’re not outraged,
you’re not paying attention!

Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.

Since the 2012 election, an increasing (though still small) number of Republican governors have caved in to their previously announced opposition to expanding Medicaid. But this is not because they are starting to become fans of the government-funded health insurance program. Instead, they are deciding their states should participate so they can get the increased federal dollars that come with such participation.

Never mind that this about-face on Medicaid expansion, which is a part of so-called Obamacare, counters their deficit-reduction mantra, which consists almost entirely of cutting spending as opposed to increasing tax revenue by having wealthy campaign contributors pay a fairer share of taxes.

Florida’s governor, Rick Scott, is one of the most recent converts to Medicaid expansion. But in return for offering to add his state to the growing list of Medicaid expanders, Scott extracted a “deal” from the Obama administration: an agreement to be allowed to privatize Medicaid in Florida. This would allow the state to operate its Medicaid program through private insurance companies, the very companies that already greatly inflate the cost of medical care due to massive administrative waste paired with a lack of ability (relative to the government) to control medical costs. Switching from a not-for-profit public insurer to a system of private health insurers is a very good “deal” for the medical industry, with its already bloated bottom lines, but not for taxpayers.

Just as Scott (like other Republican governors) hypocritically bit the Medicaid-expansion bullet to get massive federal money flowing into the state, the checks-and-balances counterweight of Florida’s legislative branch lashed out at Scott. True to Republican opposition to using federal spending for valuable, life-saving services for the less fortunate, as Medicaid does, the Republican-dominated legislature does not want to tarnish its own image by opting for more federal spending in the state. Not long after Governor Scott’s Medicaid expansion plan was announced, committees in both houses of the legislature showed their strength and defeated the proposal.

You have to be strong – and wrong – to defeat such an expansion, despite the fact that your governor had previously made a deal that would divert much more of the money into the private, for-profit health sector. And so it goes.