Gov. Rick Scott, fresh off meeting President Trump over the weekend, hinted in an interview with the Washington Examiner at how the president could address the issue of Obamacare's Medicaid expansion.
Grappling with Obamacare's expansion of Medicaid has proven to be one of the vexing challenges for Republicans seeking to repeal and replace Obamacare. The program to provide health coverage to the poor has been criticized by conservatives for costing too much and delivering few choices and substandard care. But a number of Republican governors embraced the expansion of the program in their state through Obamacare, and they are pushing back against the GOP Congress's efforts to repeal it. Maintaining the program's expansion would cost $1 trillion over a decade, but repealing it would disrupt health coverage for millions of people, according to the Congressional Budget Office.
Asked in a Tuesday visit with the Washington Examiner whether pro-Medicaid expansion Republican governors have become an obstacle to repeal, Scott said that what mattered most to him was that his state, which did not choose to expand Medicaid, was treated the same as other states — and he communicated the message to Trump.
"I've said Florida cannot be at a disadvantage," Scott said. "What I mean by that is that we have to be treated fairly. So, our taxpayers pay money to the federal government with these programs and so our taxpayers should not treated worse because we did not do an expansion, so whatever the federal government decides they want to do with regard to Medicaid, my view of this is, give me, on a per capita basis, the same amount of money and I will figure out a way to run a program that is more efficient than other states and that covers people. My family didn't have healthcare, I want people to have healthcare. It's got to be a safety net that actually works."
He continued, "So, what I've been clear is that is that if you give me the flexibility, I can run a program more efficiently."
Scott said in his discussions with Trump, the president was peppering him with questions, as businessmen do, as he was learning more about healthcare policy and developing his views. He did not want to come across as a spokesman for Trump or assume where he'd ultimately come down.
However, asked if he believed Trump was on board with increased state flexibility, Scott said, "I don't think there's any question he's going to do that. There's nothing that he's said to me that would lead me to believe he's not going to give us more flexibility. And I've known [Secretary of Health and Human Services] Tom Price a long time — for 20 years — and I'm very comfortable with where he's at. And [Vice President] Mike Pence? For sure."
Republicans have long advocated block-granting Medicaid to the states, but conservatives have been arguing that doing so while maintaining Obamacare's expansion spending levels wouldn't amount to a real repeal of the law. Asked about this, Scott said he was indifferent to how Republicans set spending levels, as long as he was given the same funding per beneficiary at other states.
"However they want to define repeal, that's not my concern," Scott said. "My concern is I want to make sure my state is treated fairly and if they want to make sure that people have access to good healthcare, they should rely on the states to provide it, to run the program. And the federal government should be a fair partner to every state. I should not be at a disadvantage to any other state. I should not be punished."
Scott has his own complicated history with Obamacare, particularly the law's Medicaid expansion. A former hospital executive who entered the political scene by launching a group opposing Obamacare, as governor, initially supported the expansion, but he was blocked from enacting it by Florida's GOP legislature. (In his Tuesday visit, he pushed back against this characterization, arguing that he was merely supporting the federal government running a program with federal tax dollars. "I will not stand in the way if the government wants to fund something," he said.)
Putting together Scott's statements with Trump's talk of state flexibility and broad coverage, it isn't difficult to see where Trump could end up on the issue. That is, he could back a plan that would provide more flexibility to the states over how to administer Medicaid, while maintaining Obamacare spending levels. This would allow him to argue that he isn't cutting Medicaid, and then tell conservatives that he's delivered on free market reforms. Incidentally, Pence pursued a similar strategy as governor of Indiana, as he embraced Obamacare's expansion of Medicaid, but negotiated some adjustments that allowed him to sell it as a free market reform. Indiana's Medicaid plan was designed by Seema Verma, who is Trump's pick to lead the Centers for Medicare and Medicaid Services.