Republican governors pushing to expand Medicaid for the poor under President Barack Obama’s health-care law are facing opposition from their own party.

In Florida, Republican Governor Rick Scott, 60, was rebuked by a Senate panel that voted yesterday against expanding Medicaid, instead deciding to craft a plan that would propose spending federal money for private insurance. A state House of Representatives committee voted March 4 against expanding Medicaid, an option for states made possible by Obama’s Patient Protection and Affordable Care Act.

At least eight of 30 Republican governors in the U.S. have backed Medicaid expansion. Of those, the five in states where their party also controls the legislature -- Scott, Arizona’s Jan Brewer, Ohio’s John Kasich, Rick Snyder of Michigan and Jack Dalrymple of North Dakota -- are facing the toughest opposition. These clashes show how difficult it will be for Obama to get his Medicaid plan widely adopted.

“These governors are looking at the bottom line and they’re realizing the kind of money they’d be walking away from if they don’t do this,” said Grant Reeher, a political science professor at Syracuse University in New York who specializes in health-care policy. “Legislators aren’t responsible for managing the state in the same way. They can hang on longer to their political opposition.”

Texas rejection

Other Republican governors, such as Rick Perry of Texas, have rejected an expansion of Medicaid, saying it’s too costly. House Republicans in Texas voted in private to side with the governor.
If states don’t expand Medicaid, millions of people earning less than the poverty line who aren’t currently eligible for the program may not have health insurance. The Obama administration is considering whether to let states use Medicaid money to buy insurance for people earning poverty-level wages in new marketplaces called exchanges, Gary Cohen, the director of the U.S. Center for Consumer Information and Insurance Oversight, said March 7.

In Arizona, Brewer’s push for expansion included a news conference last week with doctors and nurses outside the state Capitol to press lawmakers to support the measure. Expansion passed the North Dakota House last month. It faces opposition in the Senate, said Representative Al Carlson, the House Republican leader.

‘Limited’ expansion

In Florida, it took legislative committees just seven days into the 60-day session to defeat Scott’s plan, which called for a “limited” expansion that would last three years while the federal government pays the full cost. Lawmakers have until May 3, the last day of session, to change their minds.

The alternative proposed in the Florida Senate is similar to a proposal being debated in Arkansas, where Governor Mike Beebe, a Democrat, asked Health and Human Services Secretary Kathleen Sebelius on Feb. 18 if his state would be allowed to have people newly eligible for Medicaid use the exchanges.

After the Florida Senate vote, Scott said in a statement that he’s confident lawmakers will “find a way to protect taxpayers and the uninsured in our state while the new health- care law provides 100 percent federal funding.”

States decide

The U.S. Supreme Court said in June that the federal government couldn’t force states to broaden the program under Obama’s health-care law. That means states decide.

Scott started his political career by opposing Obama’s health law with a Tea Party group, Conservatives for Patients’ Rights. A former chief executive officer of HCA Holdings Inc., he said he wouldn’t expand Medicaid after the Supreme Court upheld the law, and changed his position following the November presidential election.

Scott is seeking re-election in 2014. On Dec. 19, he had an approval rating of 36 percent, according to a poll from Quinnipiac University in Hamden, Connecticut.

An estimated 3.35 million of Florida’s 19.1 million residents will receive Medicaid this year, according to the legislature’s Office of Economic and Democratic Research.

An expansion under the federal law -- which increases eligibility for a family of four earning as much as $31,800 this year -- would increase that by 1.28 million during the next 10 years, according to a November 2012 report from the Kaiser Commission on Medicaid and the Uninsured, a nonprofit group that researches health care.

Congressional approval

Obama’s health law, which passed Congress in 2010 without a single Republican vote, may extend insurance over the next decade to about 27 million people who are currently uninsured. The Congressional Budget Office estimates that 8 million more will enroll in Medicaid programs next year because of the expansion.

Expansion in Florida would cost the federal government an estimated $66.1 billion during the next 10 years, according to the Kaiser report. The state’s cost during that time would be about $5.36 billion, according to the report.

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