Guest Op-Ed: Senator Nan Rich, Health Care For Floridians: Race to the Bottom?

Florida’s legislators faced a critical moral decision as they began the 2013 Legislative Session. The
question was would they engage in a “race to the bottom” in health care by refusing to take the
federal funding for Medicaid expansion to almost 1 million low-income Floridians? Or would they
take the high road of compassion and caring for real working people who are not merely numbers
on a Legislative budget spreadsheet? Unfortunately, I am disappointed the Republican-controlled
Legislature took the low road by rejecting Medicaid expansion and the accompanying federal dollars
that would have provided healthcare to nearly 1 million Floridians.

Florida did not have far to go in a “race to the bottom” in healthcare. Florida is already 50th in the
ranking of uninsured adults (29.5%) and 48th in the ranking of uninsured children (11.9%).
The Legislative Estimating Conference determined that Florida would gain $51 billion in federal
funds (these are our tax dollars) to expand Medicaid over the next 10 years. The expansion would
cost the state $3.5 billion over the decade. In fact, several studies provide estimates that the
Medicaid expansion would add more than $2 billion to the Florida economy annually and add over
55,000 new private sector jobs. Research reports also indicate that expansion will save money in
other areas of the budget such as support for safety net hospitals, mental health and substance abuse
funding, and the Medically Needy program.

Rejecting the Medicaid expansion will have severe consequences for low-income Floridians,
businesses, and hospitals. It means leaving 100% of the federal funding on the table to be sent to
other states. This legislative decision affects real Floridians who need health care and live from
paycheck to paycheck. Without health care coverage, these are people who will end up in our
hospital emergency rooms, resulting in increased health insurance costs for everyone.
Florida’s hospitals have a high stake in this Legislative decision. Unique among all businesses in
Florida, Florida’s hospitals have a social mission to care for all Floridians who come to their emergency
rooms and may not turn them away. Because the Affordable Care Act anticipated near universal
coverage through Medicaid expansion, it included major cuts in subsidies to hospitals that serve
a large number of uninsured patients and that provide a high level of uncompensated care. For
Florida, that means at least a $1.2 billion reduction over 10 years. Exacerbating this threat, hospitals
are facing additional cuts through implementation of Diagnosis-Related Groups (DRGs); termination
of the Low Income Pool (LIP) program, which brings $1 billion annually to hospitals; and a
two percent rate cut proposed in the Governor’s Budget Recommendations!

Republican legislators have ignored the studies that indicate jobs will be brought to the healthcare
sector, that small businesses will be able to avoid the mandate penalty, and that states accepting the
federal funds for Medicaid expansion will have a competitive advantage. They also ignored the
genuine human needs of Floridians.

Ironically, while millions of state dollars have been given to private corporations with little
accountability under the name of “economic development,” the Legislature had a chance to invest
in real economic development while it also invested in the lives of Floridians.
The Legislative Session has only started so it is not too late for the Legislative leaders to realize the
opportunity that they have missed and reverse their decision. If the Republican legislators truly
believe in a “safety net” as they allege, then what they must do is clear: Vote “Yes” for Medicaid

Democratic Gubernatorial candidate Nan Rich was first elected to the Florida State Senate in 2004 after serving in the House of Representatives from 2000-2004. She served as leader of the Senate Democratic Caucus from 2010-2012 and was term-limited in November, 2012.

Senator Rich is widely recognized as one of Florida’s leading champions of children’s and social justice issues. She served on numerous Senate committees including Health and Human Services Appropriations, Vice Chair; Children, Families, and Elder Affairs, Vice Chair; Regulated Industries; Reapportionment; Environmental Preservation and Conservation; and the Joint Legislative Budget Committee.

She also served on the Children & Youth Cabinet, whose mission is to ensure that public policy relating to children and youth promotes collaboration among agencies and delivers services in a holistic manner.  Senator Rich sponsored the legislation in the Senate to create the Cabinet.


  1. […] Guest editorial from Senator Nan Rich, the only declared 2014 Democratic Gubernatorial candidate over at the Florida Squeeze. […]


  2. Blue Dog Dem · ·

    I wonder what our former Governor thinks of this subject. He’s consulting his pollsters right now to find out.


    1. Yellow Dog Democrat · ·

      After observing the Governor that we have NOW, I would wager serious Money that the People wish they had him back,( Blemishes and all)………


      1. Blue Dog Dem · ·

        Scott will be re-elected if Crist is the Dem
        Nominee. You can take that to the bank. His negatives once the campaign begins will be off the charts. Scott is unpopular but will win by default.


  3. While I respect Senator Rich’s right to run and she is a thoughtful advocate on issues resistance to Crist is futile. He is going to be the nominee and he will crush Rick Scott. Resistance is futile and the attempts by this blog and your buddy Trotter over at the Hurricane to weaken Crist by airing old scandals and odd theories about voter behavior only help the Rick Scott Republicans. You guys all do some great work but continuing to weaken our nominee will only mean four more years of Scott. You need to think about what you are doing to our party. Respectfully, you need to take a deep breathe and understand what is at stake.


    1. The Jim Greer, Harry Sargeant and Greg Eagle corruption stories are not old scandals. We’re not talking about back when Crist was a newbie in the early 90s, we’re discussing things that have come out since the last time he faced the voters. And when stories like this one ( are all over the mainstream press not years ago, but right now, what are we supposed to do, ignore them? A big difference between us and the Republicans is that we can sustain an open, intellectually honest conversation. We owe that to ourselves.

      I definitely understand your concern and we all want to beat Rick Scott, but we have to be something other than the Beat Rick Scott party in order to win.

      No one here is on a Charlie witch hunt and I think Kartik, myself and most of you would vote for him if that’s what it comes to. I just think that Scott is a sitting duck, especially now after his lieutenant has hastily resigned in disgrace. We have a good year and a half to develop a strong campaign behind someone we can really trust. We don’t have to resort to nominating a party hopper in order to win.

      I honestly believe Crist would get killed with the television ads, getting it both ways — the “allies with Obama’s socialist agenda” angle they will surely use (cf. the Nelson-Mack race) plus the “look at this hypocrite” angle — and that it will be hard to energize volunteers and voters with that dissonance in the atmosphere. I think someone other than Crist would be a better option not because I want to remain ideologically pure or grind an axe, but because I think we’d have a better chance of winning.


    2. Odd theories? Can you please tell me about your extensive history regarding political analysis?


    3. First off, this was a guest column by Senator Rich about Medicaid and Health Care not a forum about Charlie Crist running for Governor.

      Secondly, I think we need to be very careful with Crist. Trust me, the rumors and speculation about Crist and his ties to unsavory characters are much deeper and more extensive than anything the state’s newspapers or this website have printed. I can almost guarantee these become issues if he’s the nominee, given how dirty the GOP plays. On top of that we have a strong opportunity to create a strong narrative about cronyism, corruption, sense of entitlement and arrogance with the GOP leadership in Tallahassee if Crist isn’t the nominee. If we select him we must run on other issues.

      For the rest I differ to Ryan’s response below which is excellent and captures my sentiments exactly.


  4. tom james · ·

    we’re already doing Race to the Bottom in public education thanks to Obummer,Duncan, Jebster Bush, Gates, Pearson and corrupt Republicans in the legislature.
    we may as well do Race to the Bottom in health care too! I mean some poor CEO connected crook needs to make a few hundred million more dollars!


  5. Kelly K · ·

    Between Scott and Crist the people of Florida are screwed. No way will he be the nominee because all we be brought out….everything!!!!!!!!!!


  6. Realist · ·

    Those if you promoting or hoping for other candidates are idiots. Crist is the Democratic candidate and by bringing up the issues this website seems obsessed with regarding Crist is hurting the Democrats and helping Rick Scott. I wonder if you guys are really progressives. This insular firing squad has to stop. Crist will be our nominee anxiety some may think this website is simply a Republican front set up to sabotage our chance to win.

    As for Nan Rich her candidacy is only serving to help Rick Scott. One wonders if the GOP has given this site all of the anti Crist junk you publish. He is a good Democrat having done so much for the President and we must unite behind him.


    1. Didn’t he endorse McCain?



    very thoughtful piece by Sen. Rich but Charlie is winning!


  8. Dems in Action · ·

    We still have more than 18 months until the election. It is time for good, honest democrats to stand up for integrity in politics. We don’t have to settle for another scam artist. Senator Rich has as much experience as “what’s his name” and she has none of the garbage he is hauling around. Senator Rich has a plan for our future, a future that includes the 47% that Crist left behind. Join the movement and get out the vote!


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