Governors Fall Away in G.O.P. Fight Against More Medicaid

Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.

The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.

The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budget deficit. Some flatly declared they would not consider it.

In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.

The shift has delighted supporters of the law.

“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”

 Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.

Some Republican governors remain firmly opposed to the expansion of Medicaid. In her State of the State address, Gov. Nikki R. Haley said, “As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.”

Gov. Rick Perry affirmed that “Texas will not expand Medicaid” and said he was proud that Texas did not follow other states “scrambling to grab every tax dollar they can.”

The change of heart for some Republican governors has come after vigorous lobbying by health industry players, particularly hospitals. Hospital associations around the country signed off on Medicaid cuts under the health care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid.

Politics could also be a factor in states where Republican governors have decided to expand Medicaid. Mr. Obama won all of those states except Arizona and North Dakota in last year’s election, a fact that may have influenced several of the governors’ decisions. Some of the seven are also up for re-election next year.

Religious leaders have added a moral dimension to the campaign in some states. The Roman Catholic bishops of Salt Lake City and Little Rock, Ark., for example, have urged state officials to expand Medicaid.

The Obama administration has tried to win over skeptical state officials by offering new flexibility to manage Medicaid as they like. On the same day that he agreed to expand Medicaid in Florida, Mr. Scott got federal permission to move more Medicaid beneficiaries into private managed care plans.

Mr. Scott’s support for expanding Medicaid is particularly significant — Florida is the fourth most populous state — and surprising. A onetime hospital executive, he has been among the most strident critics of the health care law, and his opposition to it was a cornerstone of his 2010 campaign for governor.

The battle is not over, however. In Florida, as in many other states, expansion is subject to approval by the Legislature, whose Republican leaders have expressed misgivings. The legislative session begins next month, and advocates say they plan to press ahead with a lobbying campaign.

Leah Barber-Heinz, a spokeswoman for Florida Chain, a health advocacy group, said it was trying to inform lawmakers and the public about who would benefit from an expansion of Medicaid. More than one-fifth of Florida residents, roughly 4 million of 19 million people, lack health insurance.

“There are so many misperceptions about the uninsured,” Ms. Barber-Heinz said. “So we’re trying to show faces of who would be impacted: people who have been hit by the recession, people who have been laid off, educated people, people who own homes.”

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Governors Fall Away in G.O.P. Fight Against More Medicaid

Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.

The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.

The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budget deficit. Some flatly declared they would not consider it.

In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.

The shift has delighted supporters of the law.

“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”

 Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.

Some Republican governors remain firmly opposed to the expansion of Medicaid. In her State of the State address, Gov. Nikki R. Haley said, “As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.”

Gov. Rick Perry affirmed that “Texas will not expand Medicaid” and said he was proud that Texas did not follow other states “scrambling to grab every tax dollar they can.”

The change of heart for some Republican governors has come after vigorous lobbying by health industry players, particularly hospitals. Hospital associations around the country signed off on Medicaid cuts under the health care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid.

Politics could also be a factor in states where Republican governors have decided to expand Medicaid. Mr. Obama won all of those states except Arizona and North Dakota in last year’s election, a fact that may have influenced several of the governors’ decisions. Some of the seven are also up for re-election next year.

Religious leaders have added a moral dimension to the campaign in some states. The Roman Catholic bishops of Salt Lake City and Little Rock, Ark., for example, have urged state officials to expand Medicaid.

The Obama administration has tried to win over skeptical state officials by offering new flexibility to manage Medicaid as they like. On the same day that he agreed to expand Medicaid in Florida, Mr. Scott got federal permission to move more Medicaid beneficiaries into private managed care plans.

Mr. Scott’s support for expanding Medicaid is particularly significant — Florida is the fourth most populous state — and surprising. A onetime hospital executive, he has been among the most strident critics of the health care law, and his opposition to it was a cornerstone of his 2010 campaign for governor.

The battle is not over, however. In Florida, as in many other states, expansion is subject to approval by the Legislature, whose Republican leaders have expressed misgivings. The legislative session begins next month, and advocates say they plan to press ahead with a lobbying campaign.

Leah Barber-Heinz, a spokeswoman for Florida Chain, a health advocacy group, said it was trying to inform lawmakers and the public about who would benefit from an expansion of Medicaid. More than one-fifth of Florida residents, roughly 4 million of 19 million people, lack health insurance.

“There are so many misperceptions about the uninsured,” Ms. Barber-Heinz said. “So we’re trying to show faces of who would be impacted: people who have been hit by the recession, people who have been laid off, educated people, people who own homes.”

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The Trade: A Revolving Door in Washington With Spin, but Less Visibility

Obsess all you’d like about President Obama’s nomination of Mary Jo White to head the Securities and Exchange Commission. Who heads the agency is vital, but important fights in Washington are happening in quiet rooms, away from the media gaze.

After a widely praised stint as a tough United States attorney, Ms. White spent the last decade serving so many large banks and investment houses that by the time she finishes recusing herself from regulatory matters, she may be down to overseeing First Wauwatosa Securities.

Ms. White maintains she can run the S.E.C. without fear or favor. But the focus shouldn’t be limited to whether she can be effective. For lobbyists, the real targets are regulators and staff members for lawmakers.

Ms. White, at least, will have to sit for Congressional testimony, answer occasional questions from the media and fill out disclosure forms. Staff members, however, work in untroubled anonymity for the most part. So, while everyone knows there’s a revolving door — so naïve to even bring it up! — few realize just how fluidly it spins.

Take what happened late last month as Washington geared up for more fights about the taxing, spending and the deficit. The Senate majority leader, Harry Reid, Democrat of Nevada, decided to bolster his staff’s expertise on taxes.

So on Jan. 25, Mr. Reid’s office announced that he had appointed Cathy Koch as chief adviser to the majority leader for tax and economic policy. The news release lists Ms. Koch’s admirable and formidable experience in the public sector. “Prior to joining Senator Reid’s office,” the release says, “Koch served as tax chief at the Senate Finance Committee.”

It’s funny, though. The notice left something out. Because immediately before joining Mr. Reid’s office, Ms. Koch wasn’t in government. She was working for a large corporation.

Not just any corporation, but quite possibly the most influential company in America, and one that arguably stands to lose the most if there were any serious tax reform that closed corporate loopholes. Ms. Koch arrives at the senator’s office by way of General Electric.

Yes, General Electric, the company that paid almost no taxes in 2010. Just as the tax reform debate is heating up, Mr. Reid has put in place a person who is extraordinarily positioned to torpedo any tax reform that might draw a dollar out of G.E. — and, by extension, any big corporation.

Omitting her last job from the announcement must have merely been an oversight. By the way, no rules prevent Ms. Koch from meeting with G.E. or working on issues that would affect the company.

The senator’s office, which declined to make Ms. Koch available for an interview, says that she will support the majority leader in his efforts to close corporate tax loopholes. His office said in a statement that the senator considered her knowledge of the private sector to be an asset and that she complied with “all relevant Senate ethics rules and disclosures.”

In a statement, the senator’s spokesman said, “The impulse in some quarters to reflexively cast suspicion on private sector experience is part of what makes qualified individuals reluctant to enter public service.”

Over in bank regulatory land, meanwhile, January was playing out like a Beltway remake of “Freaky Friday.”

Julie Williams, chief counsel for the Office of the Comptroller of the Currency and a major friend of the banks for years, had been recently shown the door by Thomas J. Curry, the new head of the regulator. Banking reform advocates took that to be an omen that a new era might be dawning at the agency, which has often been a handmaiden to large banks.

Ms. Williams, of course, landed on her feet. She’s now at the Promontory Financial Group, a classic Washington creature that is a private sector mirror image of a regulatory body. Promontory is the Shadow O.C.C. The firm was founded by a former head of the agency, Eugene A. Ludwig, and if you were to walk down the halls swinging a copy of the Volcker Rule, you would be sure to hit a former O.C.C. official. Promontory says only about 5 percent of its employees come from the O.C.C., but concedes that more than a quarter are former regulators.

Promontory, as the firm explains on its Web site, “excels at helping financial companies grapple with and resolve critical issues, particularly those with a regulatory dimension.” But it plays for the other team, too, by helping the O.C.C. put into effect regulatory reviews. The dreary normality of this is a Washington scandal in the Michael Kinsley sense: a perfectly legal one.

Promontory, which demurred on a request to talk with Ms. Williams, has a different view. The firm doesn’t lobby or help in litigation. It argues that after banks stop fighting regulators and lobbying against rules, then they come to Promontory to figure out how to fix their problems and comply.

“We are known in the industry as the tough-love doctors,” said Mr. Ludwig, the chief executive of Promontory. “I am deeply committed to financial stability, and the only way to have stability is to do the right thing in both the spirit and letter of the law.”

Hmm. Remember the Independent Foreclosure Review, the program that the O.C.C. and other federal bank regulators trumpeted as the largest effort to compensate victims of big banks’ foreclosure abuses? As my colleague at ProPublica, Paul Kiel, detailed last year, that review involved consultants like Promontory essentially letting banks decide who was victimized. How well did that work? So well that the regulators had to scuttle the program because it hadn’t given one red cent to homeowners but somehow, I don’t know how, managed to send more than $1.5 billion to consultants — including Promontory.

Promontory maintains that it complied with the conditions set out by the O.C.C. And the review was replaced by a settlement, which the regulators say will compensate victims — though the average payout is small beer.

Who, exactly, makes the rules at the O.C.C.? I mentioned “Freaky Friday.” That’s because at the agency, Ms. Williams is being replaced by Amy Friend. And where is Ms. Friend coming from? Wait for it … Promontory. In March, maybe they’ll do the switcheroo back.

The O.C.C. didn’t make Ms. Friend available but said that her “talent, integrity and commitment to public service are beyond reproach” and would be subject to the rule requiring her to recuse herself for a year on matters specifically relating to her former employer.

I spoke with people who said she was a smart and dedicated public servant, an expert on the Dodd-Frank Act who can help complete the scandalously long list of unfinished rules and expedite its adoption.

“Amy Friend is absolutely rowing in the right direction,” said a Senate staff member who worked on efforts to push for stronger financial regulation.

Let’s hope so.

But people also described Ms. Friend as pragmatic. In Washington, that’s the ultimate compliment. Sadly, that has come to mean someone who seeks compromise and never pushes for an overhaul when a quarter-measure will do.

Washington today resembles something like the end of “Animal Farm.” People move from one side of the table to the other and up and down the Acela corridor with ease. An outsider looking at a negotiating table would glance from lobbyist to staff member, from colleague to former colleague, from pig to man and from man to pig and find it impossible to say which is which.

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IHT Rendezvous: What of the Ringleaders, Chinese Ask About Cultural Revolution Case

BEIJING — It’s reminiscent, perhaps, of the trials of people accused of Nazi-era crimes, a John Demjanjuk, or a Samuel K.: in China this week, a man was tried for murdering a doctor during the Cultural Revolution, the China News Service reported.

A rare episode of justice for a neglected era? Judging by a discussion on China’s biggest microblog, Sina Weibo, ordinary people don’t necessarily see it just that way; rather, some are angry that a little guy, and not the masterminds of the violence, is being punished. What about the “ringleaders,” chief among them Mao Zedong, they are saying, often obliquely?

According to the report, which was widely disseminated online via news aggregators and other sites, the defendant at the rare trial this week, in Ruian in Zhejiang province, was a 80-plus-year-old man identified only as Mr. Qiu. He strangled a Mr. Hong with a rope in 1967, on the orders of a civilian militia, which suspected Mr. Hong of spying for a rival militia, the report said. Mr. Qiu had been on the run for decades and was arrested last July.

(For an English-language account, see this article in the South China Morning Post, which may be behind a paywall.)

After the killing Mr. Qiu cut off Mr. Hong’s lower legs with a shovel “to make it easier to bury him,” and then he buried him, the report said.

Violence was common during the era: yesterday, I examined this painful time in a Letter from China and Rendezvous post about Ping Fu, the businesswoman who wrote a controversial memoir.

As I wrote in my Letter, to this day, the state tightly controls discussion about the era – when many got away with, literally, murder.

“Have the main culprits who started the Cultural Revolution been punished?” asked a person with the handle Sansu dage, who added an angry red face to the posting.

“Actually, the biggest criminals of the Cultural Revolution have not been held responsible,” wrote a person with the handle Keji huangdan menwei chuangxin. “To pursue an ordinary criminal, decades later, is absurd.”

A_Jing wrote: “There should be mandatory courses in universities to talk clearly about the crimes against humanity during the Cultural Revolution!”

Wrote another: “All the cases from the Cultural Revolution should be tried.”

That’s extremely unlikely. A few key players were tried beginning in 1980, when Jiang Qing, Mao Zedong’s wife, and other members of the Gang of Four received lengthy sentences.

Yet, “I was Chairman Mao’s dog,” Ms. Jiang said in her defense. “Whomever he told me to bite, I bit.”

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Hacking Victims Edge Into Light

Steve Ruark for The New York Times

Alan Paller of the SANS Institute said recently hacked companies were seeking safety in numbers.

SAN FRANCISCO — Hackers have hit thousands of American corporations in the last few years, but few companies ever publicly admit it. Most treat online attacks as a dirty secret best kept from customers, shareholders and competitors, lest the disclosure sink their stock price and tarnish them as hapless.

Rarely have companies broken that silence, usually when the attack is reported by someone else. But in the last few weeks more companies have stepped forward. Twitter, Facebook and Apple have all announced that they were attacked by sophisticated cybercriminals. The New York Times revealed its experience with hackers in a front-page article last month.

The admissions reflect the new way some companies are calculating the risks and benefits of going public. While companies once feared shareholder lawsuits and the ire of the Chinese government, some can’t help noticing that those that make the disclosures are lauded, as Google was, for their bravery. Some fear the embarrassment of being unable to fend off hackers who may still be in high school.

But as hacking revelations become more common, the threat of looking foolish fades and more companies are seizing the opportunity to take the leap in a crowd.

“There is a ‘hide in the noise’ effect right now,” said Alan Paller, director of research at the SANS Institute, a nonprofit security research and education organization. “This is a particularly good time to get out the fact that you got hacked, because if you are one of many, it discounts the starkness of the announcement.”

In 2010, when Google alerted some users of Gmail — political activists, mostly — that it appeared Chinese hackers were trying to read their mail, such disclosures were a rarity. In its announcement, Google said that it was one of many — two dozen — companies that had been targeted by the same group. Google said it was making the announcement, in part, to encourage other companies to open up about the problem.

But of that group, only Intel and Adobe Systems reluctantly stepped forward, and neither provided much detail.

Twitter admitted that it had been hacked this month. Facebook and Apple followed suit two weeks later. Within hours after The Times published its account, The Wall Street Journal chimed in with a report that it, too, had been attacked by what it believed to be Chinese hackers. The Washington Post followed.

Not everyone took advantage of the cover. Bloomberg, for example, has repeatedly denied that its systems were also breached by Chinese hackers, despite several sources that confirmed that its computers were infected with malware.

Computer security experts estimate that more than a thousand companies have been attacked recently. In 2011, security researchers at McAfee unearthed a vast online espionage campaign, called Operation Shady Rat, that found more than 70 organizations had been hit over a five-year period, many in the United States.

“I am convinced that every company in every conceivable industry with significant size and valuable intellectual property and trade secrets has been compromised (or will be shortly) with the great majority of the victims rarely discovering the intrusion or its impact,” Dmitri Alperovitch, then McAfee’s vice president for threat research, wrote in his findings.

“In fact,” said Mr. Alperovitch, now the chief technology officer at Crowdstrike, a security start-up, “I divide the entire set of Fortune Global 2000 firms into two categories: those that know they’ve been compromised and those that don’t yet know.”

Of that group, there are still few admissions. A majority of companies that have at one time or another been the subject of news reports of online attacks refuse to confirm them. The list includes the International Olympic Committee, Exxon Mobil, Baker Hughes, Royal Dutch Shell, BP, ConocoPhillips, Chesapeake Energy, the British energy giant BG Group, the steel maker ArcelorMittal and Coca-Cola.

David E. Sanger contributed reporting from Washington.

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In Reversal, Florida to Take Health Law’s Medicaid Expansion

MIAMI — Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect.

It was an about-face for Mr. Scott, a former businessman who entered politics as a critic of Mr. Obama’s health care proposals. Florida was one of the states that sued to try to block the law. After the Supreme Court ruled last year that though the law was constitutional, states could choose not to expand their Medicaid programs to cover the poor, Mr. Scott said that Florida would not expand its programs.

Mr. Scott said Wednesday that he now supported a three-year expansion of Medicaid, through the period that the federal government has agreed to pay the full cost of the expansion, and before some of the costs are shifted to the states.

“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Mr. Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”

He said there were “no perfect options” when it came to the Medicaid expansion. “To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”

Mr. Scott said the state would not create its own insurance exchange to comply with another provision of the law.

His reversal sent ripples through the nation, especially given the change in tone and substance since the summer, when he said he would not create an exchange or expand Medicaid.

“Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low,” Mr. Scott said in a statement at the time. “Neither of these major provisions in Obamacare will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.”

Mr. Scott now joins the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who have decided to join the Medicaid expansion. Some, like Gov. Jan Brewer of Arizona, were also staunch opponents of Mr. Obama’s overall health care law.

Shortly before his announcement, the governor received word from the federal government that it planned to grant Florida the final waiver needed to privatize Medicaid, a process the state initially undertook as a pilot project. Mr. Scott, who is running for re-election next year, has heavily lobbied for the waiver, arguing that Florida could not expand Medicaid without it.

Mr. Scott’s support of Medicaid expansion is significant, but is far from the last word. The program requires approval from Florida’s Republican-dominated Legislature, which has been averse to expanding Medicaid under the health care law. The Legislature’s two top Republican leaders said that before making a decision they would consider recommendations from a select committee, which has been asked to review the state’s options.

“The Florida Legislature will make the ultimate decision,” Will Weatherford, the state House speaker, said. “I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability.”

Medicaid, which covers three million people in Florida, costs the state $21 billion a year. The expansion would extend coverage to one million more people.

Mr. Scott’s reversal is sure to anger his original conservative supporters.

The governor “was elected because of his principled conservative leadership against Obamacare’s overreach,” said Slade O’Brien, state director for Americans for Prosperity, an influential conservative advocacy organization. “Hopefully our legislative leaders will not follow in Governor Scott’s footsteps, and will reject expansion.”

During his announcement on Wednesday, Mr. Scott said his mother’s recent death and her lifetime struggle to raise five children “with very little money” played a role in his decision.

“Losing someone so close to you puts everything in a new perspective, especially the big decisions,” he said.

Michael Cooper contributed reporting from New York.

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In Reversal, Florida to Take Health Law’s Medicaid Expansion

MIAMI — Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect.

It was an about-face for Mr. Scott, a former businessman who entered politics as a critic of Mr. Obama’s health care proposals. Florida was one of the states that sued to try to block the law. After the Supreme Court ruled last year that though the law was constitutional, states could choose not to expand their Medicaid programs to cover the poor, Mr. Scott said that Florida would not expand its programs.

Mr. Scott said Wednesday that he now supported a three-year expansion of Medicaid, through the period that the federal government has agreed to pay the full cost of the expansion, and before some of the costs are shifted to the states.

“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Mr. Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”

He said there were “no perfect options” when it came to the Medicaid expansion. “To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”

Mr. Scott said the state would not create its own insurance exchange to comply with another provision of the law.

His reversal sent ripples through the nation, especially given the change in tone and substance since the summer, when he said he would not create an exchange or expand Medicaid.

“Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low,” Mr. Scott said in a statement at the time. “Neither of these major provisions in Obamacare will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.”

Mr. Scott now joins the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who have decided to join the Medicaid expansion. Some, like Gov. Jan Brewer of Arizona, were also staunch opponents of Mr. Obama’s overall health care law.

Shortly before his announcement, the governor received word from the federal government that it planned to grant Florida the final waiver needed to privatize Medicaid, a process the state initially undertook as a pilot project. Mr. Scott, who is running for re-election next year, has heavily lobbied for the waiver, arguing that Florida could not expand Medicaid without it.

Mr. Scott’s support of Medicaid expansion is significant, but is far from the last word. The program requires approval from Florida’s Republican-dominated Legislature, which has been averse to expanding Medicaid under the health care law. The Legislature’s two top Republican leaders said that before making a decision they would consider recommendations from a select committee, which has been asked to review the state’s options.

“The Florida Legislature will make the ultimate decision,” Will Weatherford, the state House speaker, said. “I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability.”

Medicaid, which covers three million people in Florida, costs the state $21 billion a year. The expansion would extend coverage to one million more people.

Mr. Scott’s reversal is sure to anger his original conservative supporters.

The governor “was elected because of his principled conservative leadership against Obamacare’s overreach,” said Slade O’Brien, state director for Americans for Prosperity, an influential conservative advocacy organization. “Hopefully our legislative leaders will not follow in Governor Scott’s footsteps, and will reject expansion.”

During his announcement on Wednesday, Mr. Scott said his mother’s recent death and her lifetime struggle to raise five children “with very little money” played a role in his decision.

“Losing someone so close to you puts everything in a new perspective, especially the big decisions,” he said.

Michael Cooper contributed reporting from New York.

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Boeing Engineers Approve Pact, but Tech Workers Say No

SEATTLE (AP) — It's a split decision from the union representing Boeing Co.'s engineers and technical workers.

The engineers voted Tuesday to accept the aerospace company's four-year contract offer while technical workers rejected it and authorized a future strike.

Bill Dugovich of the Society of Professional Engineering Employees in Aerospace says the votes mean the new contract for the 15,550 engineers is in place.

He says negotiators hope to resume contract talks soon on behalf of the 7,400 technical workers.

A strike by the technical workers is not imminent, but Dugovich says the negotiating team is now authorized to call one. Engineers and technical workers work on plans for planes and solve problems that arise on the factory floor.

Boeing did not comment.

SPEEA last went on strike for 40 days in 2000.

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India Ink: A Personal Nightmare of Assault in India

In a hotel in southern India, in the midst of a dreamless sleep, I awoke inside a nightmare. I heard someone screaming. I’m not sure how much time passed before I realized that it was my scream.

I had traveled to India on behalf of a U.S.-based organization to film a documentary about political street theatre and how art is used as a tool for social change. It was the continuation of field research that I had begun as a William J. Fulbright Scholar. As a second-generation American born to parents who emigrated from India, I felt a sense of pride that I could use my role as a filmmaker to serve as a cultural ambassador between the two largest democracies in the world.

But I found myself awake in this nightmare, with a man violently gripping my mouth shut, attempting to rape me. I was biting and kicking, using every ounce of my energy to fight for my life. My mouth was badly bleeding and in the struggle we fell to the floor. He continued to violently grab my face, and said, “Shalini, don’t shout.” He knew my name. I recognized him as the hotel waiter who served my dinner that night.

I continued to scream and fight incessantly, until finally he relented. He picked up his lungi and said, “I’ll leave. Don’t tell the manager.” Then he ran out and shut the door. Did he really think he could try and rape me in my sleep, without protest and that I wouldn’t tell? Yes. He did. He counted on the fact that he lived in a culture that blamed the victim — that the stigma associated with sexual assault would force a woman to keep quiet. And although I had escaped the worst-case scenario, and prevented a rape, the nightmare was far from over.

In the days that followed, bruised and battered, with excruciating body pain, I managed to shuttle to and from government hospitals to be examined and police stations to file reports. I was well acquainted with India’s bureaucratic process, and in spite of my injuries, I wanted to make sure I had filled out all the paperwork correctly to obtain “justice.”

For several weeks, I tried to get a response from several American and Indian bureaucracies, but they all responded the same way: by doing nothing. Despite my formal complaints, in which I detailed the attack in full, these institutions offered no assistance – not even a single follow up call. I was devastated. I traveled to India on part of an American organization, and received no mental, physical or emotional support. As someone who has committed my life to artistic expression and social justice, I have never felt so voiceless.

Rape and sexual assault are not isolated incidents in a woman’s life. The physical wounds can heal, but the psychological and social stigma associated with rape can keep a woman from reaching her highest potential. My mother had always raised me with the idea that I could lift myself up from my bootstraps and follow my dreams. But in the years following the sexual assault, I suffered the worst depression that I had ever known. I finally sought out a free clinic for survivors. The counselor explained to me, “You have something called post-­‐traumatic stress disorder (PTSD). You have the stuff soldiers have coming home from a war.” Had I not found someone who could diagnose me with PTSD, and tell me this was a real and treatable condition, this assault may have held me back for life.

The recent gang rapes in India are a reminder to all of us that the rapists are not the only persons who are guilty. The onlookers, the institutions that turn a blind eye, and fail to implement comprehensive policies to address sexual assault are complicit in the violence. When these crimes are swept under the carpet, it perpetuates a culture of silence, a culture that blames the victim.

In the mainstream coverage of the recent gang rape in India, there is a kind of colonial mentality to view these men as savages, and to see India as a place that oppresses women. But looking at figures in the U.S., every two minutes a woman is sexually assaulted. One in four American women suffer rape or attempted rape by the time they reach college.

When I first started to share my story, I was astounded by just how many women began sharing their stories with me. It was like a common secret that we were all hiding. And I grieved not just for my own loss of innocence, but also for just how ordinary my story is, for the invisible war that is happening against women everyday. Sexual violence against women is ubiquitous. It happens to women everywhere, however educated, however empowered, across boundaries of race, class, and nationality.

We can longer wait for the death of another woman to break the silence of so many victims of sexual violence. U.S. and Indian institutions must move quickly to implement comprehensive policies regarding education, training, and support as well as clearly defined medical and legal protocol to deal with women who are sexually assaulted at home and abroad.

Healing from this traumatic event has been a journey towards deep compassion for myself, for my attacker, and for the people and institutions that betrayed me in my time of need. This story is for the courageous women who have been betrayed by the institutions they loved and served. This story is for the 40,000 women in India who are still waiting for justice for sexual assault. My case is among them. And in the silence, I can hear their scream.

Shalini Kantayya is the director of 7th Empire Media and a 2000 Fulbright Scholar.

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Bits Blog: Tech Predictions for 2013: It's All About Mobile

If there is one theme that will be the topic of digital business this year, it is mobile.

ComScore, which tracks Web and mobile usage, published a report about what happened in 2012, and what to expect in 2013.

It shows that the effects of a movement toward mobile are everywhere, from shopping to media to search. According to the report, “2013 could spell a very rocky economic transition,” and businesses will have to scramble to stay ahead of consumers’ changing behavior.

Here are a few interesting tidbits from the 48-page report.

The mobile transition is happening astonishingly quickly. Last year, smartphone penetration crossed 50 percent for the first time, led by Android phones. People spend 63 percent of their time online on desktop computers and 37 percent on mobile devices, including smartphones and tablets, according to comScore.

Just as they compete on computers, Facebook and Google are dominant and at each other’s throats on phones.

Google’s map app for the iPhone, which had been the most used mobile app, lost its No. 1 spot to Facebook after Apple kicked Google’s maps off the iPhone in October. Now, Facebook reaches 76 percent of the smartphone market and accounts for 23 percent of total time spent using apps each month. The next five most used apps are Google’s, which account for 10 percent of time on apps.

As mobile continues to take share from desktop, some industries have been particularly affected, and they are seeing significant declines in desktop use of their products as a result. They are newspapers, search engines, maps, weather, comparison shopping, directories and instant messenger services.

The most visited Web sites are not so surprising: Google, Yahoo, Microsoft, Facebook and Amazon. Facebook continues to take up most of our time online.

But there were a few surprises from younger, smaller Web companies. Tumblr was No. 8 on the list of sites, ordered by time spent on them. And several Web sites were breakout hits last year, as measured by growth and visitor numbers: Spotify (music), Dropbox (online storage), Etsy (shopping), BuzzFeed (news), JustFab (shopping), SoundCloud (music) and BusinessInsider (news).

Search, one of the biggest and most reliable Web industries, is at a crossroads, comScore said. Even though the search market continues to be extraordinarily profitable, there is a desire for it to evolve and offer new services to users.

Here is some evidence: Searches on traditional search engines, dominated by Google, declined 3 percent last year, and the number of searches per searcher declined 7 percent. Yet searches on specialty sites, known as vertical search engines, like Amazon.com or Whitepages.com, climbed 8 percent.

Social search, based on what users’ friends like, has put Facebook and Google on a “collision course,” comScore said, particularly in searches for local businesses like restaurants.

In social networking, the visual Web, as comScore calls it, has transformed the landscape. Pinterest, Tumblr and Instagram, all of which emphasize images, each gained more than 10 million visitors last year.

Last year was also pivotal for online video, comScore said, as viewers increasingly seek the ability to watch video when and where they want. Watching TV shows online helped last year break viewing records, especially during the Olympics.

In the United States, 75 million people a day watch online video and stream 40 billion videos a month, and viewing is driven by YouTube.

There has also been a turning point for video ads. They cost more than typical ads, and have always lagged behind viewership. But in 2012, 23 percent of videos were accompanied by an ad, up from 14 percent the year before. More TV ad dollars are coming to online video, comScore concluded.

Though e-commerce spending grew 13 percent last year, it was a disappointing holiday season online, largely because of economic pressures. Purchasing on mobile phones is beginning to make a dent in e-commerce, comScore said, with mobile shopping accounting for 11 percent of e-commerce in the fourth quarter of 2012, up from 3 percent in the period two years earlier.

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