The federal government is out of money. Everyone knows this. President Obama knows it, Congress knows it, our neighbors know it, even our kids know it. The United States is $15 trillion in debt, and that figure grows by leaps and bounds every second. But at least Uncle Sam has the luxury of printing more cash to help pay the bills.
The State of Florida does not have that option. And even though unemployment has declined faster in our state than almost any other over the past 18 months, we’re still climbing our way out of a substantial economic hole.
The citizens of Florida wisely added a balanced budget amendment to the state constitution in 1994. The result? Unlike President Obama and Congress, as Florida’s governor, I cannot run a budget deficit to pay for government programs. Tough budget decisions must be made every year in order to comply with state law.
Florida’s share of Medicaid payments in the last fiscal year was more than $9 billion. And that number is growing three and a half times faster than the state’s general revenue is growing. In short, every year, Florida’s Medicaid program eats a larger and larger share of the revenue pie. Expanding Medicaid now would only accelerate that unsustainable growth.
The big-government health care advocates who designed Obamacare knew that states like Florida would balk if they had to fork up billions more to pay for a Medicaid expansion, so they relied on the federal government’s ability to print billions of new dollars to pay for the up-front costs. Many recent news stories and opinion pieces tout the fact that the federal government will pay 100 percent of the expansion costs for the first three years. It sounds great, until you ask the important question: What then?
After those three years, the federal government expects Florida to find hundreds of millions more taxpayer dollars—more than $2 billion in increased costs between now and 2020 alone, according to the Kaiser Foundation—and that’s on top of the roughly $9 billion (and growing) we’re already spending on Medicaid each year.
This November, we will choose the next president of the United States and a new Congress. Those leaders will decide the fate of Obamacare. But by striking down the portion of the law that would have forced states like Florida to funnel billions of dollars into expanding Medicaid, the Supreme Court has mercifully provided states the flexibility to choose.
After carefully considering the implications, at least eight other governors have announced their states will join Florida in opting out of the Medicaid expansion. It couldn’t have been a difficult choice. Florida, for example, already has programs in place that provide health care coverage to those who need it. And expanding access to insurance doesn’t solve America’s biggest health care problem: out-of-control, rising costs.
In 2009, a year before deciding to run for governor, I founded Conservatives for Patients’ Rights and proposed an alternative health care reform plan designed to bring costs under control. It relied on four free-market principles: letting patients make their own health care choices; increasing competition by making providers disclose prices and performance; extending to individuals the same insurance tax breaks as employers; and rewarding healthy choices and personal responsibility. If Obamacare is repealed, states have plenty of alternatives for fixing health care, and they won’t break the bank.
But even if Obamacare is never repealed, its ultimate fate will be determined by those states that reject the Medicaid expansion. States that opt in will be compared to those that opt out, and Americans will be able to see the difference between responsible governance and rampant spending. I am confident Florida will succeed where other states fail. The result will be more financial flexibility to provide tax cuts or fund programs that deliver proven results. Compare that outlook with a state like California, which is already broke, and the contrast becomes clear.
The federal government still hasn’t learned that you shouldn’t spend money you don’t have. Florida’s citizens learned that lesson long ago.