Dr. Robert Brooks, associate vice president for health care leadership at USF, points to the story of former state Rep. Ed Homan, an orthopedic surgeon from Tampa, who once said he sees Medicaid patients from as far away from Jacksonville because they can’t get seen closer to home.

“My point is just expanding the number of people in a dysfunctional system doesn’t necessarily result in the quality outcomes we’d like to see,” Brooks said.

Brooks also said that while the federal government is picking up the bill for expansion in the first three years, “expanding Medicaid coverage will result in an ongoing obligation of the state for many years to come.”

And Scott told Van Susteren it’s also possible that the federal government won’t deliver on its promise to cover the bulk of the expansion.

“Look, every government program in the world, they say, “I’m going to cover everything.’ They run out of money. They’re not honest…,” he said. “And then there’s no one to take care of you. That’s exactly what this will do.”

Scott repeated his concerns about spending when asked on Friday about expanding Medicaid.

“Your state budget is primarily tied to education, corrections and health care, which is primarily Medicaid,” he said. “Ultimately it ends up being a choice between education and health care.”

Scott also said government programs run out of money and should not be used to provide health insurance.

Whether Scott’s “no” to an expanded Medicaid program is the last word remains to be seen. Though hardly fans of the federal health care law, state legislators weren’t as emphatic after the Supreme Court ruling, and they also get a say in the decision-making.

State Sen. Joe Negron, R-Stuart, who chairs the Senate committee that oversees health care spending, said the Legislature is studying Medicaid expansion and will consider the issue next year.

He acknowledges the cost-shifting that happens when the uninsured get treated in ERs, but is concerned about expanding the program, especially when the federal government can ramp back its contributions in later years.

“My goal is we explore market-driven ways to make sure that more Floridians have affordable health insurance,’’ he said.

It’s worth noting that the original Medicaid program wasn’t accepted by all states when it first began. Today, every state participates. If Scott and the current Legislature don’t approve an expansion, it’s possible that future leaders might not be so opposed — and that will keep the debate over Medicaid going for years to come.

Carvalho said the safety-net hospitals believe that expanding Medicaid is the most realistic way of covering a very poor population. There just aren’t many other options on the table.

“Saying no to the opportunities afforded in the act, in the Medicaid expansion, is no solution,” he said. “No solution to the people who would receive coverage, and no solution in that Florida would then be subsidizing other states that took advantage of it.

“The Affordable Care Act is not a perfect solution. Medicaid is not a perfect program. But it does provide a major step to providing coverage to those uninsured in the state. We support that, absent other alternatives.”

Times staff writers Charlotte Sutton and Lee Logan contributed to this report.