Florida Problem #947: We're Led By Crooks and Crazies

Back to the brewing disaster that is Republican leadership in the state of Florida.  To wit, the fight over the state budget over Medicaid funding.  To the Tampa Bay Times coverage:

Blaming the federal government for Florida's financial woes, Gov. Rick Scott on Tuesday said he was prepared to call Florida lawmakers back for a special session to complete the budget — and even encourage them to pass a bare-bones budget if necessary...
"...If (lawmakers) fail to cut taxes in this legislative session, it is clear that cutting taxes by more than $1 billion will become the top priority for next year's legislative session when there is no longer any uncertainty around health care funding, which is already over 40 percent of our state's $77 billion budget..."
...The statement came as the Senate and House convened rare meetings — one in the open and the other out of the public eye — but showed no signs of ending the budget showdown that has crippled the legislative session.
During a closed-door meeting, House Speaker Steve Crisafulli, R-Merritt Island, could be heard encouraging the Republican caucus to hold firm in its opposition to Medicaid expansion, one of the key sticking points of the session...
...Senate President Andy Gardiner, meanwhile, received a standing ovation from the entire Senate — and applause from lobbyists and activists in the audience — when he said the Senate would continue its fight for expanded coverage.
One of Gardiner's top lieutenants, Senate budget chief Tom Lee, called out the House and Scott for failing to discuss the issue in a public meeting.
"I do not think that the House or the governor wants this blood on their hands when this cart goes into the ditch because people will not come to the table and have an honest political discussion about legitimate differences we have over health care funding..."

There's Rick "Never My Fault The State I Run Is Broken" Scott blaming the federal government for something he as governor is supposed to do himself.  Then again, what did you expect from a guy who never took responsibility for his healthcare company committing massive acts of Medicare fraud?

So why the crisis?  Why the split between what's usually been a unified state Republican den of thieves?

...With just 10 days left before the 60-day session is scheduled to end, the House and Senate remain at odds over how to handle a potential $1.3 billion hole in the state health care budget.
Its source: the federal government's plan to end the Low Income Pool, a program that helps hospitals cover the costs of treating uninsured and Medicaid patients.
If the program expires on June 30, as it is scheduled to do under an agreement with the U.S. Centers for Medicare and Medicaid Services (CMS), it could result in an $86 million budget cut for Tampa General Hospital and a $200 million budget cut for Jackson Health System in Miami. Children's hospitals throughout the state stand to lose $117 million.
State health officials have formally petitioned the federal government to continue the program and presented a Senate plan to distribute the funds more evenly than in the past. But it remains unclear how the Legislature would provide support to hospitals if the funding fell through.

The LIP program was a Bush the Lesser era law that helped finance Medicaid-style block grants.  When Obama oversaw the passage of the ACA "Obamacare" program, LIP still co-existed as an alternative.  Especially after the Supreme Court ruling that eventually protected Obamacare but changed the mandatory Medicaid funding to an optional plan.  However, this year Obama's administration said it would phase out LIP - which they're not required to continue - in favor of the Obamacare funding.

This created an ideological choking point for the Republicans.  On one hand, Republicans realize that any loss of federal funding on this scale is a huge hit to their annual budgets that they cannot hide without raising taxes (suicide with their anti-government wingnut base) or slashing other vital programs too deep (suicide with the rest of the state including a lot of businesses that rely on state aid).  On the other hand, Republicans hate Obama to the point that ANYthing Obamacare is toxic to them, even when it works.

Hence the split.  Scott campaigned in 2010 and 2014 to the Far Right in opposition to Obamacare.  The state House is filled with a lot of gerrymander-safe wingnuts who can hide from the general public and play to their base without retribution.  The state Senate doesn't have that luxury: fewer in number and higher-profile - they're usually the ones who run for congressional seats later in their careers - these are the ones fully aware of the human costs if Medicaid funding disappears and 800,000 Floridians are suddenly sh-t out of luck.

That 800,000 covers kids, families, elderly... hospitals and nursing homes rely on Medicaid funding to keep the doors open.  We're a major retiree state with a lot of those retirees thinking the Republicans are serving them.  What do you think will happen when most of them find by June that the Republicans are the ones that screwed them instead?  Despite Scott's efforts to pin this on Obama, it's up to HIM and the Florida legislature to work things out.  The Republicans can easily come up with an alternative means of accepting the Medicaid funding without calling it dreaded "Obamacare": other states have done so.  But Scott won't even budge on that one compromise.

Let's see what Johathan Cohn at the Huff Po says about this:

...Conservatives have plenty of genuine, intellectually honest reservations about the changes that came with Obamacare. They don't like the new government spending and regulation, for example. In some cases, conservatives object to the whole notion of government-sponsored insurance.

But the Florida dispute demonstrates that differences over policy can't, on their own, explain the fervor now on display. The law and its enactment have tapped into something deeper and more primal -- about what the law represents, or, perhaps, the president who signed it...

...But Florida's budget situation is about to change, in ways that make opposition more difficult for these officials to justify. Like many states, Florida hospitals have access to some special federal grants designed to offset the losses that they take when they provide discounted or free care to the poor. These grants date back to a Bush-era program, enacted before the Affordable Care Act was around to give those same people insurance. The federal government has discretion over when to make those grants and, last year, the Obama administration made clear it would not be renewing Florida's beyond 2015, now that the Affordable Care Act's Medicaid money is there for the taking.

Republican leaders in the state Senate understood the implications. They'd have a big hole in the budget to fill unless they came up with some other way to finance health care for the poor. Among the first things to go would be a tax cut that Republicans cherish. "It really puts everything at risk," Andy Gardiner, leader of the Senate Republicans, told The Washington Post's Greg Sargent, who's been following the story closely. "It jeopardizes the tax cuts, it jeopardizes increases in education funding, it jeopardizes our priorities."

Rather than give up on those, Senate Republicans passed a bill to expand Medicaid, albeit with a few conservative modifications. (The merits of those modifications, and what they'd do to Medicaid, are subjects for another day.) It's precisely the strategy that Republican officials in Arkansas and Michigan, among other states, have used. But Florida House Republicans, who met behind closed doors on Tuesday, aren't budging. And neither, it seems, is Scott. Instead, he's decided to sue the federal government -- on the theory that, by refusing to extend the special grant for hospitals, the Obama administration is engaged in unconstitutional coercion of a state.

Gardiner has called Scott's decision "difficult to understand." It's even more difficult to understand given the math.

A few years ago, the Kaiser Family Foundation published an analysis by researchers at the Urban Institute. It projected the cost of expanding Medicaid in each state and then broke down the implications for state budgets. The numbers for Florida were striking. Over 10 years, the researchers found, making Medicaid available to all low-income people would cost about $71 billion above and beyond what the state's Medicaid program would otherwise cost.

That's a lot of money, for sure. But roughly $66 billion of the total, the researchers found, would come from the federal government. That would leave Florida taxpayers on the hook for the remaining $5 billion, with at least some of that money coming back to them in the form of reduced spending on other programs.

To put it another way, expanding Medicaid in Florida would likely require a net investment by state taxpayers that, over the course of a decade, would work out to less than a half-billion dollars a year. That's without accounting for any additional growth and tax revenues that the huge infusion of federal dollars might provide. That's also without accounting for the more than $1 billion a year in that, without expanding Medicaid, Florida would probably have to scrounge up in order to help hospitals defray the cost of charity care.

In short, if the numbers were lopsided in favor of expanding Medicaid before, they are even more lopsided now. And it's not as if anybody is arguing seriously that those grants are a superior way of financing care for the poor. If anything, the opposite is true -- and it's one reason the editorial page of the Tampa Bay Times called Scott's position "indefensible." Other editorial pages, civic organizations, and business groups across the state have made similar statements.

In response, Scott has said he's just looking out for state finances, because the federal government might someday pull back on its Medicaid commitment and leave state government responsible for financing a much larger Medicaid program. But as another Kaiser report has noted, the federal matching rate for Medicaid has remained remarkably stable over time -- except for rare changes that, on balance, meant the feds were paying more.

Of course, conservative fervor to block or repeal the Affordable Care Act has always seemed a bit disconnected from reality, given that the law consists almost entirely of pieces that existed, without such fuss, long before Obamacare came along. The lone exception is the "individual mandate," the requirement that people carry insurance or pay a fee. And that's an idea that plenty of conservatives tolerated -- and some even supported -- less than a decade ago. In fact, it was a conservative expert at the Heritage Foundation who many historians credit with the idea.

No, the level of hostility to Obamacare makes very little sense -- unless it's about something beyond the policy particulars. It could be the fact that Democrats finally accomplished something big, for the first time in several decades, thereby expanding the welfare state at a time when conservatives thought they were on their way to shrinking it. Or it could be the idea that, on net, the Affordable Care Act transfers resources away from richer, whiter people to poorer, darker people. Or it could be the fact that "Obamacare" contains the word "Obama," whose legitimacy as president at least some conservatives just can't accept...

There's the reason why Florida is screwed: the dominant state party - Republicans - hates Obama.  And it's an irrational hate, based on a fictional persona pumped up by wingnuts and Fox Not News.

If we get to June and there's no Medicaid funding, it's an irrational hate that's gonna get a lot of Floridians killed.  And that won't be the fault of Obama: it will be the fault of a governor and state-level Republican Party that can't swallow its pride and recognize that government can work if you know what you're doing.