Rick Scott’s refusal to expand Medicaid deprived Floridians of health care

Rick Scott has been one of the staunchest opponents of Medicaid expansion, with a long history of going back-and-forth on the issue. Here’s where he stands today. 

Florida is one of 10 states that has not expanded its Medicaid eligibility under the Affordable Care Act’s Medicaid expansion, an opt-in program that allows states to expand health insurance coverage to those who are uninsured and earn below a certain threshold. 

As a result, nearly 1 million people across the Sunshine State don’t have potentially life-saving health insurance, with roughly 400,000 of those falling in the coverage gap—ineligible for Medicaid and also ineligible for tax subsidies to help them afford private health insurance via the Affordable Care Act marketplace. 

Rick Scott, the Senator from Florida running for reelection in November, has been one of the staunchest opponents of Medicaid expansion, albeit with a long history of going back-and-forth on the issue. So, where does he stand today? 

A timeline of Scott’s stance on Medicaid

• Before he ran for governor in 2010, Scott spent $5 million of his own money in 2009 to form Conservatives for Patients’ Rights and oppose President Barack Obama’s Affordable Care Act.
• For much of his first term (2011 – 2013), Scott refused to expand Medicaid, because it was, in his estimate, “too costly.” In reality, the federal government covered the entire cost of Medicaid expansion from 2014 to 2016, 95% of the cost from 2017 to 2019, and 90% of it since 2020, leaving states to cover the remainder. While the cost wouldn’t be nothing, the benefits of expansion would outweigh the costs. In fact, Florida could save $200 million per year by expanding Medicaid, according to an analysis by the Florida Policy Institute. 
• Scott’s first flip came on Feb. 20, 2013, when he declared that he supported expanding Medicaid, calling it a “compassionate, common-sense step forward.” His push for the expansion was lukewarm, though—he didn’t campaign for it or pressure lawmakers from his own party—and the Florida legislature did not approve the expansion.
• In 2014, as he campaigned for governor against Charlie Crist, who promised he would work for Medicaid expansion, Scott remained mum on the issue, avoiding it during the race, which he barely won in November. 
• Then in April 2015, Scott announced he no longer supported Medicaid expansion.
• Later that same month, Scott sued the Obama administration, accusing federal officials of trying to coerce the state to expand Medicaid by withholding funds for the Low-Income Pool (LIP) program that supports health care providers that give uncompensated care to Florida residents who are uninsured or underinsured. Scott dropped the lawsuit in June of 2015 after federal officials agreed to extend the hospital funding for two additional years.

Blocking expansion hurts the most vulnerable

The refusal to expand Medicaid hurts the most vulnerable across the state. Yet the benefits of expansion are clear: it would allow Floridians earning up to 138% of the federal poverty level—about $41,400 for a family of four—to get health insurance. 

A report by the Center on Budget and Policy Priorities issued in 2019 estimated that, between 2014 and 2017, Florida likely suffered the second-highest total of death in that time period — 2,776 — due to the state’s refusal to expand Medicaid. Texas came in first, with 2,920 deaths.

In contrast, the benefits of expanding Medicaid could potentially make a significant difference in people’s physical and mental health and overall wellbeing by:

• Granting access to preventative care as well as regular check-ups for chronic conditions such as diabetes and hypertension.
• Increasing early-stage cancer diagnosis.
• Decreasing the numbers of patients receiving surgical care inconsistent with medical guidelines.
• Increasing the number of people receiving medication-assisted treatment for opioid use disorders.
• Providing greater access to mental health care.
• Improving maternal health outcomes by providing regular and postpartum medical attention.

The benefits, however, go beyond healthcare access. Medicaid expansion has also been shown to create new jobs in healthcare and increase in revenue for hospitals that may be struggling financially. 

And according to the Center on Budget and Policy Priorities (CBBP), expanding Medicaid would help provide financial security to low-income adults who struggle to pay their medical bills, and reduce the number of evictions among low-income renters, among other benefits.

Groups with the largest coverage gains would include non-Hispanic Black people, young adults, and women, and particularly women of reproductive age, something that takes on added importance after Florida’s extreme 6-week abortion ban took effect May 1. 

“If a patient is underinsured or uninsured, she’s going to be affected to a greater degree,” Dr. Cecilia Grande, a Puerto Rican OB/GYN with a practice in Florida, says the ban will especially hurt women who lack health insurance. 

RELATED: Florida group launches campaign to put Medicaid expansion on 2026 ballot