MIAMI -- Republican Gov. Rick Scott may have gotten ahead of himself when he recently dropped the bombshell that he now supports expanding Medicaid by an estimated 900,000 residents under President Barack Obama's health care overhaul.
Minutes after Scott's announcement, House Speaker Will Weatherford pointed out that Medicaid expansion required legislative approval. That battle between the Republican governor and the Republican-dominated Legislature could dominate the annual 60-day legislative session, which begins Tuesday.
"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," Weatherford said.
Health committees in the House and Senate are still painstakingly making their way through presentations on the expansion and haven't made any decisions, but behind the scenes maneuverings have been telling.
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Former Gov. Jeb Bush recently visited the state Capitol while Scott was out of
town and privately encouraged House Republicans to create an alternative proposal instead of expanding Medicaid, though he apparently did not offer a specific plan.
Rep. Richard Corcoran, who chairs a House committee charged with implementing the Affordable Care Act, said "skeptical would be a nice way to describe where I stand." But he stressed the committee is still weighting options and won't make a decision until they've completed the review process.
"There's a lot of skepticism about whether the federal government has the ability to do what they say they're going to do. I have a lot of skepticism about a one-size-fits-all program that is generally not quality health care," said Corcoran, R-Land O' Lakes.
Republican Sen. Joe Negron, R-Stuart, who chairs the Senate committee that oversees health care, said they are close to making a recommendation "but we're not there yet." He hoped to have a recommendation in early March that focuses on making "sure that the state of Florida lives within its means and we don't commit ourselves to a course of action that is unsustainable in the years ahead."
Scott only wants to expand Medicaid for three years or as long as the federal government foots 100 percent of the bill. He also said it would be unfair for Florida taxpayers to pay for the expansion nationally but get nothing in return.
But lawmakers worry it will be difficult to stop the program in three years if it is already providing services.
"One of the fears that is often expressed on this committee is that would never happen... that Florida would not be able to sort of scale back our commitment to the expansion population," said Rep. Jose Javier Rodriguez, D-Miami.
Lawmakers and state agencies are also playing a bit of catch-up in implementing the federal health law after waiting nearly two years hoping the Supreme Court would overturn it. Democrats have criticized state agencies, particularly insurance regulators, for not working on a back-up plan in the meantime. State regulators are facing a flood of filings as health insurance companies start filing for approvals needed to comply with the federal law.
"There was a philosophy, an ideology that this shouldn't be the law even though it was the law. We don't have a contingency plan. We're reacting now at the 11th hour essentially and we're flat-footed and completely underprepared to implement that law as it is," said Rep. Dwight Dudley, D-St. Petersburg.
Some political experts predict Republican lawmakers will not toe the party line on Scott's proposal.
"They are not facing a tight reelection battle, by and large, and as a result they don't have to placate the middle," said Dan Smith, a University of Florida political science professor.
The decision will have long-lasting repercussions in a state with one of the highest rates of uninsured residents in the country and some of the most stringent eligibility requirements. A family of three with income of $11,000 a year makes too much and single residents are not covered. The bulk of residents getting coverage under the Medicaid expansion will be childless adults.
The federal government's offer to cover most of the cost of expansion is much more generous than the roughly 50 percent matching rate that federal health officials currently pay for Medicaid. The state spends about $21 billion a year to cover roughly 3 million patients -- about half are children.
Lawmakers have long complained Medicaid is consuming the state budget and passed sweeping legislation in 2011 to privatize the program statewide. The new Medicaid population under the federal health overhaul will get coverage under the privatization proposal that federal and state health officials are still hammering out. The program would allow for-profit providers to determine the health care for Medicaid recipients with the goal of saving money and improving services
Federal officials recently said they plan to approve the privatization request if the state beefs up accountability measures and uses real-time data that evaluates whether the program is actually improving patient care along the way as promised, not just at yearly benchmarks. The state must also hold regular meeting with health advocates, patients and insurers and hire an ombudsmen to oversee the portion of the program that involves tens of thousands of elderly, long-term care patients.
For now, Florida will allow the federal government to run the state health exchange, an online marketplace where businesses and individuals can shop for health plans and find out if they qualify for subsidies.
But lawmakers have had lengthy discussions about partnering with the feds or running the program themselves in the future. In an odd twist of party ideology, many conservatives, who typically bristle at federal government intervention, are urging states to allow the feds to run their exchanges.