Medicaid Expansion Fuels Gridlock

Ray Pilon knew he’d said something that could land the state representative in hot water with the leadership of the Florida House.

The fight over extending health coverage to more low-income Floridians was heating up, with House Speaker Steve Crisafulli calling a premature end to the legislative session last week rather than debate the issue with a state Senate that favors Medicaid expansion.

Pilon sounded off to a reporter, saying he was “very disappointed” with how the session ended and that he supports accepting additional Medicaid funding from the federal government under the right circumstances.

The Sarasota Republican was frustrated. So he spoke out. Then he quickly sent Crisafulli a text message trying to smooth things over. Dissension on such a big issue is not viewed favorably in the House, especially when Republican leaders have declared they’re at “war” against Medicaid expansion.

Pilon’s efforts to balance a policy position he believes his constituents support against a desire to maintain his role in the power structure illustrates just how explosive the Medicaid issue has become in Florida. It also underlines the complicated political calculations legislators are making as healthcare for the poor becomes the central focus of state politics.

Many policy debates get heated, but there has been nothing like this in Florida in recent decades. The Medicaid question has thrown state government into disarray, an outcome even more remarkable because the struggle is entirely within the GOP, which controls all the levers of state power…yet even as they argue about the merits of Medicaid expansion, critics also are appealing to a more visceral distaste among conservatives towards anything associated with Obamacare.

POLITICALLY CHARGED
Opposition to Obama’s healthcare reform law remains a driving force in Republican politics. The Republican controlled U.S. House of Representatives has voted dozens of times to repeal the law.

“Obamacare is a polarizing issue and you have a lot of politicians on the right who, either out of ambition or fear, want to be perceived as not giving an inch,” said New College of Florida political science professor Frank Alcock.

The healthcare law is “this very symbolic identity-defining issue for the far right that goes beyond the substance of the policy discussion,” Alcock added.

And while most polls have shown a majority of Floridians support Medicaid expansion, many Republican lawmakers have safe seats and are more worried about being beaten in a GOP primary than appealing to the broader public.