Florida first, Florida strong: A conservative case for expanding Medicaid
Miami Herald
11 September 2025
By Joel Rudman
This article originally appeared in the Miami Herald.
Joel Rudman, a physician and former Republican Florida House member, says Florida should expand Medicaid. Getty Images
As a family physician and former Republican state representative, I’ve long believed in Florida First and that compassionate, common-sense conservative principles should guide our healthcare policy.
As such, I support Medicaid expansion in Florida because it meets all three of these criteria.
As a state representative from Navarre, health insurance was paid for, putting members woefully out of touch with the actual cost of coverage.
Now, as a private citizen, my family’s health insurance costs more than $25,000 a year. I would tell my colleagues there aren’t many families that can afford that. These are not freeloaders — they’re waitresses, construction workers, gig workers and caregivers.
The federal government has offered to extend Medicaid coverage to many of our working poor; we simply have to accept the money. Expanding Medicaid in Florida would certainly be the compassionate thing to do.
Right now, the federal taxes you and I pay go to fund Medicaid. Miami-Dade, one of the largest counties in the nation, has the highest ACA enrollment in both Florida and the country, meaning the stakes here are enormous.
BecauseFlorida hasn’t expanded Medicaid,our taxpayer dollars are sent to California, New York and other states that did. That’s money we could have used to strengthen our rural hospitals, reduce uncompensated care and give hard-working Floridians access to affordable coverage.
Washington does not refund our taxes if we refuse to expand. Instead, Washington uses our money to pay for Californians’ care. Doesn’t it make sense that Floridians’ money should be used in Florida to cover healthcare for Floridians?
Now, with the One Big Beautiful Bill, Florida can enact expansion with conservative principles. President Trump’s bill includes work requirements for able-bodied adults and flexibility to design accountable Medicaid programs. At the same time, it preserves enhanced federal funding for expansion. That’s a win-win.
The federal government has done what conservatives asked: added personal responsibility while keeping the funding on the table. Refusing to expand Medicaid now is no longer about principles — it’s just leaving money on the table and lives on the line.
Conservative states like Indiana, Utah and Arkansas have implemented Medicaid expansion in ways that promote work and reduce dependency. Florida should do the same.
We Republicans hate to be painted as heartless and out of touch, but we give that appearance when we ignore the pleas of people working two or three jobs who cannot afford a $25,000 healthcare premium.
I want Republicans to run Florida for the next 100 years; yet, by refusing Medicaid expansion for our hardest-working citizens, we are giving our political opponents the club with which to beat us over the head.
If our elected officials refuse to act, Republican voters should consider adding this language to the ballot so our voices can be heard.
As Republicans, now is the time to cement our legacy, heed the cries of the working class, follow our Christian teachings and expand Medicaid along conservative principles. It is quite simply the compassionate, common-sense, conservative thing to do.
Joel Rudman is a physician and former Republican member of the Florida House representing Florida’s 3rd district until 2024. A board-certified family doctor, he operated the Holley Navarre Medical Clinic in Navarre and focused his legislative work on healthcare policy, medical conscience protections and conservative priorities.
