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To hear Gov. Rick Scott and Charlie Crist tell it, the 2014 gubernatorial campaign isn’t about policy positions, but more about which candidate did less as governor.
Take the Affordable Care Act’s Medicaid expansion. No, really, someone should take it, because neither governor did. Now each is berating the other for it.
"He will not lift a finger to get Medicaid expansion done," Crist said during Tuesday’s CNN debate in Jacksonville. He said Floridians are suffering from the resultant lack of medical care, plus the loss of jobs the expansion has been predicted to bring.
Scott answered by first accusing Crist of running up the state’s debt. "And then you want to talk about Medicaid," he said. "You were governor when it passed. Why didn't you get it passed right then? Why didn't you expand it right then?"
Say, why didn’t he expand it right then? Could Crist have even done anything about the Medicaid expansion while he was in office? We decided to look into the assertion and find out.
How a bill contains a flaw
One of the original provisions in President Barack Obama’s signature health care law was to expand Medicaid, the joint federal and state program to cover the poorest of the uninsured. The new Medicaid guidelines covered everyone up to 138 percent of the federal poverty level.
In Florida, this would have amounted to between 800,000 and 1 million residents getting coverage. The federal government would have paid 100 percent of the costs for the first three years starting in 2014, gradually decreasing to 90 percent by 2020.
To get the funds for this expansion, the Affordable Care Act presented states an all-or-nothing proposition: Change state law to cover every eligible resident and get the expansion money, or refuse to comply and lose all federal money for Medicaid. That isn't just the expansion money, that's every dollar for a state's Medicaid program -- billions of dollars every year -- a move critics immediately decried as overwhelmingly punitive.
Crist was in the final year of his term in office, prepping for an ill-fated Senate run, when Obama signed the bill into law on March 23, 2010. Florida joined Virginia and a dozen other states in suing the federal government the same day, insisting Washington couldn’t force citizens to buy insurance and protesting the terms of the Medicaid expansion. Elements of the law were slated to take effect in stages (the Medicaid expansion wouldn't take effect for more than three and a half years, until 2014), so many states waited to see what happened with the lawsuit.
What’s a governor to do? The Republican-controlled Legislature had already started its 60-day law-making session, so it’s possible Crist could have pushed for compliance with the law then. But considering legislators begin work on bills in the September prior to a session, and given how unpopular the new law was to begin with, this was a pretty unlikely scenario. Also, the state of Florida only creates budgets one year at a time, and too much of the law's specifics were up in the air to be fully addressed in 2010.
"I think it would have been difficult, but perhaps not impossible, for Charlie to have moved on the Medicaid expansion, because components of the law were very uncertain with the ACA at that point in his term," Kevin Walsh, assistant political science professor at Broward College, told PolitiFact Florida.
The Scott campaign told us Crist could have addressed expansion in a special session. But that's impractical. There was no rush to implement an expansion of Medicaid -- remember, it wouldn't start until 2014 -- and there was little to no chance Republican lawmakers would agree to the expansion even if Crist called them back (at a cost of around $45,000 a day).
The idea of creating compliant legislation so quickly wasn’t practical either, experts told us. (A special session Crist called that year to debate offshore oil drilling was ended on a GOP party line vote after 49 minutes.)
"Technically, Scott is correct," said Gail Wilensky, senior fellow for the Center for Health Affairs at Project HOPE. "However, since the benefit wasn't going into effect for a couple of years, there wasn't an obvious need to pass legislation immediately."
The U.S. Supreme Court eventually ruled on June 28, 2012, that while the federal government could compel people to buy health insurance, it couldn’t threaten to withhold Medicaid money for refusing to comply. That made the expansion a choice for each state. By then, Scott was in office.
Most states -- even those that overwhelmingly supported expanding Medicaid -- waited until the Supreme Court decision was final to formally expand their Medicaid programs through legislation.
Before this year’s campaign, Crist said little on the Medicaid expansion.
In March 2010, he said he was against the Affordable Care Act and favored repeal. In July 2010, he waffled back and forth on repeal but still wanted it modified. And within two hours on Aug. 27, he said both he would have voted for the bill and against it.
For the record, Crist now says he is for it.
Scott, an opponent of the Affordable Care Act, initially was against the Medicaid provisions, largely because of concerns about added costs for state taxpayers (that 10 percent we mentioned). In 2013 he had a change of heart, but still did not push the Legislature to enact a law for more Medicaid coverage. To this day, Florida has refused the expansion.
Crist has floated the idea that he could issue an executive order if elected, in the same vein as Ohio Republican Gov. John Kasich. Kasich signed an executive order last year expanding the program, using an obscure government entity called the controlling board.
Florida doesn’t have one of those, so it’s unclear if Crist could take similar action. Scott certainly doesn’t think so.
"An expansion of Medicaid could not be accomplished on a whim from the executive office," Scott said in October. "It requires legislative action."
Scott said Charlie Crist could have expanded Medicaid after the health care law passed but didn't.
Experts we talked to said that was possible, with an assist from the Legislature, but not at all likely. The law was too new for legislation to be passed during the 2010 legislative session. Even if Crist had wanted lawmakers to discuss it, they would have been hostile to the idea. The state was a plaintiff in a lawsuit against the government, and there was no urgency to enact such sweeping change.
The statement contains an element of truth but ignores critical facts that would give a different impression. We rate the statement Mostly False.
CNN, Florida gubernatorial debate, Oct. 21, 2014
CNN, "Florida governor announces run for Senate," May 12, 2009
CNN, "10 states line up to sue over health bill, Florida AG says," March 23, 2010
Associated Press, "Florida's Medicaid overhaul on fast track to managed care," April 12, 2010
Orlando Sentinel, "Crist calls special session on offshore-drilling ban, rankling Republicans," July 8, 2010
Miami Herald, "Party-line vote ends Florida's oil drilling ban special session," July 20, 2010
Wall Street Journal, "Crist Uses His Old Party as a New Foil," July 20, 2010
PolitiFact Florida, "Marco Rubio says Charlie Crist has taken 'six different positions' on health care law," Sept. 2, 2010
Kaiser Family Foundation, "States Getting a Jump Start on Health Reform’s Medicaid Expansion," April 2, 2012
New York Times, "Supreme Court Upholds Health Care Law, 5-4, in Victory for Obama," June 28, 2012
South Florida Business Journal, "Debate ensues after Scott rejects Medicaid growth," July 6, 2012
Kaiser Family Foundation, "A Guide to the Supreme Court’s Decision on the ACA’s Medicaid Expansion," August 2012
National Conference of State Legislators, "U.S. Supreme Court and the Federal Health Law," Nov. 12, 2012
Washington Post, "Florida rejects Medicaid expansion, leaves 1 million uninsured," May 5, 2013
National Conference of State Legislators, "2011-2014 Health Insurance Reform Enacted State Laws Related to the Affordable Care Act," June 17, 2014
PolitiFact Florida, "By not expanding Medicaid, Florida is missing out on 63,800 jobs, Charlie Crist says," July 9, 2014
Kaiser Family Foundation, "Status of State Action on the Medicaid Expansion Decision," Aug. 28, 2014
The Advisory Board Company, "Where the states stand on Medicaid expansion," Sept. 4, 2014
Orlando Sentinel, "Crist team explores Medicaid expansion," Sept. 15, 2014
National Conference of State Legislators, "State Laws and Actions Challenging Certain Health Reforms," Sept. 30, 2014
Tampa Bay Times, "Scott, Crist split on Medicaid expansion," Oct. 12, 2014
Kaiser Family Foundation, "Implementing the ACA: Medicaid Spending & Enrollment Growth for FY 2014 and FY 2015," Oct. 14, 2014
PolitiFact Florida, "Charlie Crist says Medicaid expansion could lead to 120,000 jobs," Oct. 15, 2014
Interview with Greg Blair, Scott campaign spokesperson, Oct. 22, 2014
Interview with Gail Wilensky, senior fellow for the Center for Health Affairs at Project HOPE, Oct. 22, 2014
Interview with Timothy Jost, Washington and Lee University law professor, Oct. 22, 2014
Interview with Kevin Walsh, Broward College political science professor, Oct. 22, 2014
Interview with Lance deHaven-Smith, Florida State University political science professor, Oct. 22, 2014
Interview with Anthony Carvalho, Safety Net Hospital Alliance of Florida president, Oct. 22, 2014
Interview with Chris Lee, Kaiser Family Foundation spokesperson, Oct. 22, 2014
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