Gov. Rick Scott's cruel indifference to Floridians who can't afford medical care illustrates why he is the state's worst governor in the last half-century. He has no empathy for its people, no credible explanation for his position and no interest in reasonable compromise. The conservative Republican prefers to wage an ideological fight with the Obama administration without regard for the human and financial costs, and that is morally and economically indefensible.

It comes as no surprise that Scott renounced his support last week for accepting billions in federal Medicaid expansion money. He has been silent on it for months, assuming the issue would fade and the Legislature would not touch it. But opinion polls show voters support taking the federal money, and a broad coalition of businesses offered a sensible plan to use the money to subsidize the cost of private insurance for more than 800,000 low-income Floridians. The Senate unanimously approved a state budget that includes the bipartisan proposal, the more conservative House refused to include the Medicaid expansion money, and the pressure was on the governor to provide some leadership.

Instead, Scott reversed himself. The governor who said two years ago that he would accept the federal money because he could not "in good conscience deny the uninsured access to care'' had a change of heart and opposes it. Scott says the Obama administration cannot be trusted to follow through, but he is the one who has failed to act in good faith.

Remember that Scott opposed the Affordable Care Act that includes Medicaid expansion when he first ran for governor in 2010. Then he announced he would accept the Medicaid expansion money in 2013, just hours after the Obama administration agreed to waivers the governor sought to transform Medicaid into a privatized managed care system. Yet Scott's silence was deafening in the following weeks as two conservative Republicans from Pasco County, then-House Speaker Will Weatherford and top lieutenant Richard Corcoran, refused to let the House adopt the plan that was passed 38-1 by the Senate. If there is a trust issue, it is in the Governor's Mansion.

Scott's excuse for changing his position now on Medicaid expansion money is that the Obama administration says it will stop sending more than $1 billion a year to the state's Low Income Pool this summer. That money goes to hospitals and community health centers to help cover the cost of treating the uninsured and the underinsured, and the federal government made clear last year it would extend the payments for one final year ending this June. Yet Scott included that federal money in his 2015-16 proposed budget as though it would magically keep coming. If there is a lack of integrity in funding health care programs, it is in the Governor's Mansion.

The governor is pushing $673 million in tax cuts, and two-thirds of that total would come from reducing a tax on cable, satellite and cellphone services. Annual savings on those services for a typical family: $43. Yet Scott refuses to embrace a health care plan that would bring several billion federal dollars each year to Florida, subsidize health insurance by far more than $43 a year for low-income residents, and save state taxpayers more than $1.7 billion over five years that is spent on health care. If there is a failure to responsibly manage the public's money, it is in the Governor's Mansion.

After Scott narrowly won re-election just five months ago, he called for an end to partisanship and promised to help Floridians live the American dream. That dream includes good health and access to affordable health care. Yet Scott has broken his promise to accept Medicaid expansion money. His proposed state budget included other health care money that the federal government long ago told him would not be coming. The state surgeon general chosen by Scott would not even offer his opinion last week of the Senate plan to use Medicaid expansion money when pressed by frustrated senators, who then declined to confirm his appointment.

This is a pivotal moment for Florida and for hundreds of thousands of residents desperate for access to health care. The financial and moral arguments for accepting the Medicaid expansion money are strong. The governor will not lead, so he has to be led. That leadership has to come from the Florida Chamber of Commerce, Associated Industries of Florida, hospitals and other health care advocates, the League of Women Voters, AARP, Senate Republicans and Democrats and every pragmatic business and voter who recognizes this is in the best interest of our state and our residents.