Florida Gov. Rick Scott’s history on health care issues may prove a political minefield in his bid for the Senate, as his state continues to face one of the highest rates of uninsured people in the country.
That’s only one part of the challenge Scott will face in this policy arena. From his career as a disgraced former health care executive to his shifting position on expanding Medicaid, the governor’s checkered past when it comes to health care is set to be a significant issue on the campaign trail.
Health care has always played an oversized role in Florida, according to Democratic political strategist Steve Schale. “We’re a state that has a large immigrant population, we have a larger number of children that don’t have health insurance, and then we also have a significant senior population that’s dependent on Medicare,” he said. He noted that recent polling places health care as a top issue in Florida and the country generally.
An April HuffPost/YouGov poll, for instance, found that American voters are more likely to say they’re focused on health care than on any other issue.
And it has not taken long for Democrats to use health care concerns in Florida against the Republican governor as he seeks to unseat Democratic Sen. Bill Nelson. The Democratic Senatorial Campaign Committee launched a new site called “Self-Serving Scott” just days before his anticipated announcement to run for Senate.
Among the criticisms is his flip-flop on expanding Medicaid and a reported tax break he would have gained had the Affordable Care Act been repealed.
If the state were to expand Medicaid, more than 500,000 Floridians who are currently living in a coverage gap where Medicaid eligibility ends and marketplace health-insurance assistance begins would obtain coverage, according to analysis by the Florida Policy Institute, which has historically pushed for Medicaid expansion.
“The policies that the state’s gone forward with have really opted not to give the uninsured coverage, but rather to rely on things like the Low Income Pool,” said Anne Swerlick, policy attorney and analyst at the institute.
Florida’s Low Income Pool provides funding to health care providers that give uncompensated care to the uninsured. The pool was at the center of a lawsuit that Scott brought in 2015 against the Obama administration for discontinuing the program. He described the administration’s move as an attempt “to coerce Florida into Obamacare expansion by ending an existing federal health care program and telling us to expand Medicaid instead.”
Scott also argued that Medicaid expansion would force Floridians off of private insurance plans they have through the federal exchange, causing a “forced interruption in health care services and consumer choice.”
The lawsuit was eventually dropped, and last year, Scott was able to secure from the Trump administration a commitment of $1.5 billion annually for the Low Income Pool. But the Florida Policy Institute argues that local financial commitments would allow the state to realize just half of that money.
“The difference in federal funding between the Low Income Pool and if we expanded Medicaid—we’re talking about billions of more dollars that would come into the state with Medicaid expansion,” Swerlick said.
Florida has a growing Puerto Rican population that could likely benefit from Medicaid expansion, Schale said. He added that one disadvantage for Scott is that this election cycle will be less focused on jobs and the economy, and more focused on the affordability of living, including health care.
“Any time that the issue frame moves away from what he’s strongest—which is being a CEO who’s created jobs—it makes it harder,” Schale said. “Obviously anytime that health care drives the conversation, then it just reintroduces his ACA past in a way that he doesn’t like. The ACA stuff works for him when he can talk about it as an executive that creates jobs, but if he has to talk about it in terms of health care, it doesn’t work in his favor.”
While Scott’s website does not lay out specific health policy ideas, it does touch on his time in the health care industry. “He ultimately ran the world’s largest healthcare company, with hundreds of thousands of employees from across the world,” the website states.
But this history may also not play in his favor. The Democratic Senate Majority PAC, in anticipation that Scott would enter the Senate race, ran an ad highlighting his tenure as CEO for the hospital chain Columbia/HCA, where he resigned in 1997 after federal agents began investigating the company for Medicare fraud. This incident did not prevent Scott from winning two governor races, however.
Beyond his business history in this area, some advocates are concerned about where he wants to take the entitlement program for people above the age of 65. The National Committee to Preserve Social Security and Medicare immediately endorsed Nelson, saying Scott was the wrong choice for Florida seniors.
“During his 2010 gubernatorial campaign, Scott advocated privatizing Medicare, Medicaid and veterans’ health services. He appeared sympathetic to the idea of privatizing Social Security, as well,” the group said in a statement. “Last year, he endorsed the Republican plan to block-grant Medicaid, which could lead to huge funding cuts and reduced eligibility—or loss of coverage—for 4.3 million low income Floridians.”