The debate over whether to continue the refusal to expand Medicaid or go to Washington with a program proposal has caused a split in the Republicans in Tallahassee.  They are now facing a budgetary crises because LIP (Low Income Pool) a grant to help cover the cost of healthcare for the uninsured will expire June 30. The State of Florida was told a year ago by the CMS that this funding would expire but Rick Scott included it in the budget for this year.  

Florida was given one year expansion of LIP last year to help the state move towards a Medicaid expansion program. The letter that was sent to Florida at that time can be read here.

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/fl/Managed-Medical-Assistance-MMA/fl-medicaid-reform-implement-renewal-req-ltr-04112014.pdf

Rick Scott at that time was in favor of expanding Medicaid while he was running for a second term but has since changed his mind. This is not playing well with the insurance industry and health care industry. Hospitals in the state will have to lay off employees and cut services, also the insurance providers will lose revenue that would come in from new coverage. This will make health care cost more in the state. 

Also right now, in Florida, Governor Rick Scott wants to enact hundreds of millions of dollars in annual tax cuts.

The budget room for those tax cuts, in other words, exists because the federal government is spending money—money that comes with no guarantee—in a way that bolsters Florida’s resistance to Obamacare.

Not keen on financing opposition to itself, the Obama administration is leaning toward ending this sweet arrangement, and phasing out the Low Income Pool, which has in any case grown obsolete in a world where Florida can adopt the Medicaid expansion and provide insurance to nearly a million of its poor citizens.

http://www.newrepublic.com/article/121563/rick-scott-medicaid-expansion-opposition-killing-his-tax-cuts

In other words, Scott wants LIP to finance his tax cuts.  He and the Legislature will have to decide if they want the tax cuts they will have to take a form of Medicaid expansion or turn down the Medicaid and give up the tax cuts. 

The State Senate has worked on a program to take to Washington under the leadership of Andy Gardiner (R-Orlando) that will cover 800,000 Floridians with private insurance. Some state have done this type of program using Medicaid expansion funds with the approval of Washington. The Senate bill passed 36 - 0 but the lower chamber refuses to budge on this and Scott has flipped back to a no. 

In an interview with me, Republican state senate president Andy Gardiner — the leader of Senate Republicans, who want the Medicaid expansion — essentially confirmed that the resistance to it is putting tax cuts, and the entire state budget, in peril.

“It really puts everything at risk,” Gardiner said. “It jeopardizes the tax cuts, it jeopardizes increases in education funding, it jeopardizes our priorities.”

The short version of the dispute is as follows. Florida has been negotiating with the Obama administration over expanding Medicaid in the state to some 800,000 people under the Affordable Care Act. But Governor Rick Scott seriously complicated things the other day when he pulled back his previous support for the expansion.

http://www.washingtonpost.com/blogs/plum-line/wp/2015/04/08/gop-governors-resistance-to-obamacare-is-so-strong-that-its-jeopardizing-his-quest-for-tax-cuts/

In walks American For Prosperity, a Koch Brothers. backed group, lobbying against the Medicaid expansion, into the fray.  They sent mailers out to districts to all the supporters of the Senate Bill SB7044 for Medicaid expansion. Here is the mailer that was sent out in the Orlando area in Gardiner's district last month.

http://v6mx3476r2b25580w4eit4uv.wpengine.netdna-cdn.com/wp-content/uploads/2012/06/AFPFL-SenateOpposeMedicaid6x9-GardinerSD13.pdf

They have also started running TV ads.  Rick Scott wants to run for Senate in 2018 and wants the Koch Bros. support, so he backed off of his support of expansion. 

The local activist and lobbyist are running their own campaign.  In fact they have been at it before the last election. The group is called A Healthy Florida Works that is made up of Healthcare providers, Insurance, local Chambers of Commerce and business. Here is a sample of the current ads they are running. 

These Mayors are all Democrats in the Tampa bay area.  They are all heavy weight politically. But it shows the bipartisan support for this bill.

They are also running 30 second spots for all the Republican Senators that have supported this bill. All the ads are just like this one. 

This fight is really heating up and the legislative session is almost over with.  No budget has passed and Rick Scott has threaten to call a special session.  There was a special closed door meeting on Tuesday with the lower chamber Republicans. Florida has a Sunshine Law the prevents more then 3 legislators to meet behind closed doors.  The media was locked out but a reporter listen through the crack in the door. What it shows is that there must be a split in the lower chamber Republicans on this. All that was said was to rally them to stand firm. You can watch the local news coverage of this closed door session. it gives you a better idea how bad things are getting.

http://www.myfoxtampabay.com/story/28864125/republican-lawmakers-lock-public-out-of-medicaid-meeting  

In the meantime Rick Scotts answer to this is to go to court. 

 In February, CMS told Florida that the funding, as they’d indicated a year earlier, would not be renewed. Panic ensued, which led to the most recent development: Rick Scott is suing the Obama administration to compel CMS to renew the LIP funding, claiming that the administration is trying to coerce Florida to expand Medicaid under the Affordable Care Act.

Since his initial opposition, Scott’s gone back and forth on whether he supports expanding Medicaid, but at the moment he’s against it, and he’s using the expiration of the LIP funding as justification for saying no. “The same federal government that offers some money for a program is walking away from another health care program,” Scott said a couple of weeks ago. “How can you feel comfortable picking up another federal program when they are walking away from an existing program?”

That’s nonsense. The LIP funding, as noted, is subject to the discretion of CMS. Funding for expanded Medicaid is backed by the force of law. Even Republicans in the state aren’t buying it. “The federal government has no obligation to provide LIP funding, or to work within our timeframe,” the Republican president of the Florida Senate said in a statement. The bottom line is that Scott very much wants federal healthcare funding. What he doesn’t want, as Greg Sargent observes, is for that funding to be associated with “Obamacare.”

http://www.salon.com/2015/04/20/rick_scott%E2%80%99s_obamacare_debacle_florida_man_traps_himself_in_wholly_unnecessary_medicaid_fight/

This is going to backfire.  They can drag this out in special sessions and stay at a impasse because of Koch money but reality is the state will lose quality health care for even the people who can pay. People will notice when the local ER closes. 

Why give more tax breaks?  We are losing millionaires in South Florida. The Villages have picked up some but on the whole Florida is circling the drain. 

The tri-county region had about 9,000 fewer millionaire households in 2014 compared with two years earlier — even as the population grew by 87,181 households, estimates Phoenix Affluent Market, a marketing research company that tracks affluent and high-net-worth Americans.

http://www.sun-sentinel.com/business/personal-finance/fl-south-florida-millionaires-20150416-story.html