Why Rick Scott and other GOP governors are likely to buckle on Medicaid

Florida Republican Rick Scott and other Republican governors and state legislators are threatening to refuse federal Medicaid funds under the Affordable Care Act, as they now have the right to do after last week’s ruling by the Supreme Court on “Obamacare.”

Close to half of the estimated 17 million people who would qualify for Medicaid under the law live in states with Republican governors (see theGrio’s look at the fight over the new Medicaid funds). If Scott and Texas’ Rick Perry alone refused to implement the new Medicaid rules, more than three million low-income Americans could be denied coverage. (The provision expanding Medicaid is supposed to go into full effect in 2014.)

But don’t expect this to actually happen. The governors will eventually accept the money. A few months before a presidential election, with conservative activists watching them closely, it’s easy and perhaps even politically-necessary for these Republicans to talk tough about refusing the Medicaid money. “Obamacare” is deeply unpopular among conservatives, so any Republican governor will face pressure to distance himself from the law in any way possible.

But can they make this move in reality? The Kaiser Family Foundation, as first reported by the Washington Post’s Ezra Klein, estimates that the federal government will send $20 billion dollars to cover the uninsured between 2014 and 2019 to the state of Florida alone. Florida, in that period, would spend only $1 billion. Texas would spend $2 billion and get $52 billion from the federal government for Medicaid coverage.

Covering the uninsured is not just an ideological issue, splitting Democrats from Republicans. Hospitals and local governments spend millions each year paying for the coverage of people who don’t have health insurance. Key figures in the medical industry in these states, even if they lean more conservatively on other issues, are likely to push for the governors to accept the Medicaid funds. $20 billion in federal funds, compared to spending $1 billion a year, is a very hard deal to refuse.

Follow Perry Bacon Jr. on Twitter at @perrybaconjr