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To Florida now, where yesterday's Supreme Court decision came as a complete shock to some elected officials. Florida's Republican Governor Rick Scott and his administration have done as little as possible to comply with the law. But now that the Supreme Court has acted, NPR's Greg Allen reports from Miami that Florida officials have some tough decisions ahead.
GREG ALLEN, BYLINE: Hours after the court decision yesterday, Governor Scott said he wasn't yet ready to accept the program that he calls Obamacare as the law of the land. I have to look into it, he said. For Scott, opposing President Obama's health care plan has been a signature issue. He's a former hospital CEO, who in 2009 formed an advocacy group that worked to stop it. After it passed, Scott spent $70 million of his own money in a successful bid to become Florida's governor. Yesterday, his message was the same as it's been for the past three years.
GOVERNOR RICK SCOTT: This is going to be devastating to our economy, but probably more importantly, it's going to be devastating to patients. If you look at every government program in the world, they over-promise, they run out of money, they underpay providers, and that rations care.
ALLEN: Even before Governor Scott took office, Florida was a major player in the effort to overturn the president's healthcare law. Hours after the law was passed, Florida attorney general Bill McCollum filed a lawsuit challenging it. Eventually, 25 other states signed on, and the state's new attorney general, Pam Bondi took up the cause. She held a news conference yesterday in Tallahassee.
PAM BONDI: All of us are disappointed, of course, by the ultimate outcome today. But we cannot lose sight of what we accomplished.
ALLEN: Now that it's settled, Florida officials have lots of work to do if they're to meet the deadlines written into the law. Florida has passed on more than $100 million in federal grants intended to help it get ready. The grants are for everything from setting up exchanges where individuals and businesses can shop for healthcare plans to outreach programs for those eligible for Medicaid.
And on that issue - Medicaid - attorney general Bondi says Florida has a decision to make. The Supreme Court essentially said that for states, the decision whether to expand Medicaid eligibility to include more of the uninsured, is optional.
BONDI: We have a choice and I can tell you, it has to go to our legislature. We have to work with our governor, and we have to decide what to do next. Because were we expecting this ruling? No, of course not.
ALLEN: About four million people in Florida, currently, are uninsured. Leah Barber-Heinz of the healthcare advocacy group Florida Chain says expanding Medicaid would cover about a million of them. Under the law, the federal government would pick up nearly all of the costs of Medicaid expansion for the first few years.
Barber-Heinz says one of her group's top priorities now is to educate the public and convince elected officials that taking the federal money and expanding the program is in everyone's best interest.
LEAH BARBER-HEINZ: Medicaid expansion is expected to increase state spending on Medicaid over the next decade by only two percent. And it just wouldn't make any sense for the people of Florida, for public officials not to draw down expansion dollars.
ALLEN: Expanding Medicaid would mean fewer Floridians showing up in hospital emergency rooms without insurance. Jim Nathan, CEO of the Lee Memorial Health System in Fort Myers, says that would be a positive development. But he says for health care providers, the Supreme Court decision now brings a new challenge - significant pressure to reduce costs.
JIM NATHAN: So if more people are covered, the government is expected to find the money to cover more people, then what we'll probably see is dramatic reductions in reimbursement.
ALLEN: That means hospitals and other providers will have to collaborate more, remove inefficiencies and rework the way they deliver healthcare - a tough assignment. But while the details of how to implement the healthcare plan may be tricky, the politics appear simple.
Republican Congressman Connie Mack is running to replace Florida Democrat Bill Nelson in the Senate. Yesterday, in a conference call with reporters, he said he's confident Florida voters will reject the plan, and Nelson, who backed it, come election time.
REPRESENTATIVE CONNIE MACK: In my office, the phones are ringing off the hook. People are - a lot of the people in the state of Florida feel the same way I do.
ALLEN: Democratic Senator Nelson's response was a little more subdued. In a statement, he said, quote, "A lot of us feel the health-care law wasn't perfect. But it was needed." Changing the subject, Nelson said: Now I think it's time we finish the job of fixing our economy and creating more jobs. Greg Allen, NPR news, Miami.
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