Good morning, and welcome to the Essential California newsletter. It’s Tuesday, May 23. I’m Noah Bierman, a reporter for The Times based in Washington.
Florida Gov. Ron DeSantis is planning to open a presidential bid this week by making the case that his peninsula on the Atlantic is a model conservative city-state, a red fortress thwarting blue states such as California.
It’s not a new stance for DeSantis: His attempts to push his state further to the right have drawn him into a public rivalry with Gov. Gavin Newsom on a growing number of topics as each governor seeks to raise his own state’s profile ahead of the 2024 election. DeSantis has mostly emphasized culture war issues — whether and when to teach children about systemic racism and gender; whether it was right to shut down schools and require masks and vaccines during the pandemic; how to treat corporations that have adopted liberal stances on the environment and the aforementioned gender issues.
His strategy represents a marked shift from how governors used to run for president — showing off how their state has handled the budget, taxes, the economy and services to their constituents. Beyond questions about his tactics and personality, his candidacy will test whether the old issues still matter in a Republican Party that has been transformed by former President Trump’s media-driven style of populism.
This week, I tackled one of those bread-and-butter issues: healthcare. I traveled to a low-income clinic outside of Miami, where nearly half the patients have no insurance. I met people who have gotten catastrophic illnesses such as heart failure that probably would have been treated in 40 other states.
Florida’s social safety net — or lack thereof — has gotten surprisingly little attention in the run-up to DeSantis’ presidential bid. But it’s a policy area that shows some of the starkest differences between his state and most of the rest of the nation, including California.
Florida is one of just 10 states that have not signed on to an Obamacare expansion that allows more low-income people to qualify for Medicaid. The latest two to do so, North Carolina and South Dakota, have Republican-led legislatures. South Dakota, where Republicans outnumber Democrats 2 to 1, approved a ballot measure to do so in November.
“Many people, including me, expected that by now, more than a decade after the passage of the Affordable Care Act, the symbolism of Obamacare would have faded and more states would take advantage of the option,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “But that hasn’t happened everywhere.”
As a result, Florida has the nation’s third-highest rate of uninsured people under 65, 15.1%.
DeSantis seldom discusses healthcare, even though he was a leading Obamacare opponent when he served in Congress. His memoir published this year barely mentions it, speaking mostly about healthcare in the context of the pandemic. Opposition to Obamacare, once a driving force in Republican politics, appears to have faded. But DeSantis has still apparently determined that there is little to no political upside to expanding Medicaid using largely federal money.
California has moved in the opposite direction. Before Obamacare, more than 20% of the under-65 population lacked insurance. Now, it’s down to 8.1%, according to the latest comparison data from 2021. The state is trying to shrink that number even further by adding undocumented people to the Medicaid rolls, without the federal matching money that states get for other forms of Medicaid expansion.
It’s costly, and Gov. Gavin Newsom is struggling with a $31.5-billion budget deficit.
Is it worth the cost? It’s the kind of debate we used to have. But so far, we aren’t.
You can read the full story here: DeSantis wants to ‘make America Florida.’ That could mean many more uninsured.
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