Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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Many States Say Cuts Would Burden Fragile Recovery

States are increasingly alarmed that they could become collateral damage in Washington’s latest fiscal battle, fearing that the impasse could saddle them with across-the-board spending cuts that threaten to slow their fragile recoveries or thrust them back into recession.

Some states, like Maryland and Virginia, are vulnerable because their economies are heavily dependent on federal workers, federal contracts and military spending, which will face steep reductions if Congress allows the automatic cuts, known as sequestration, to begin next Friday. Others, including Illinois and South Dakota, are at risk because of their reliance on the types of federal grants that are scheduled to be cut. And many states simply fear that a heavy dose of federal austerity could weaken their economies, costing them jobs and much-needed tax revenue.

So as state officials begin to draw up their budgets for next year, some say that the biggest risk they see is not the weak housing market or the troubled European economy but the federal government. While the threat of big federal cuts to states has become something of a semiannual occurrence in recent years, state officials said in interviews that they fear that this time the federal government might not be crying wolf — and their hopes are dimming that a deal will be struck in Washington in time to avert the cuts.

The impact would be widespread as the cuts ripple across the nation over the next year.

Texas expects to see its education aid slashed hundreds of millions of dollars, which could force local school districts to fire teachers, if the cuts are not averted. Michigan officials say they are in no position to replace the lost federal dollars with state dollars, but worry about cuts to federal programs like the one that helps people heat their homes. Maryland is bracing not only for a blow to its economy, which depends on federal workers and contractors and the many private businesses that support them, but also for cuts in federal aid for schools, Head Start programs, a nutrition program for pregnant women, mothers and children, and job training programs, among others.

Gov. Bob McDonnell of Virginia, a Republican, warned in a letter to President Obama on Monday that the automatic spending cuts would have a “potentially devastating impact” and could force Virginia and other states into a recession, noting that the planned cuts to military spending would be especially damaging to areas like Hampton Roads that have a big Navy presence. And he noted that the whole idea of the proposed cuts was that they were supposed to be so unpalatable that they would force officials in Washington to come up with a compromise.

“As we all know, the defense, and other, cuts in the sequester were designed to be a hammer, not a real policy,” Mr. McDonnell wrote. “Unfortunately, inaction by you and Congress now leaves states and localities to adjust to the looming threat of this haphazard idea.”

The looming cuts come just as many states feel they are turning the corner after the prolonged slump caused by the recession. Gov. Martin O’Malley of Maryland, a Democrat, said he was moving to increase the state’s cash reserves and rainy day funds as a hedge against federal cuts.

“I’d rather be spending those dollars on things that improve our business climate, that accelerate our recovery, that get more people back to work, or on needed infrastructure — transportation, roads, bridges and the like,” he said, adding that Maryland has eliminated 5,600 positions in recent years and that its government was smaller, on a per capita basis, than it had been in four decades. “But I can’t do that. I can’t responsibly do that as long as I have this hara-kiri Congress threatening to drive a long knife through our recovery.”

Federal spending on salaries, wages and procurement makes up close to 20 percent of the economies of Maryland and Virginia, according to an analysis by the Pew Center on the States.

But states are in a delicate position. While they fear the impact of the automatic cuts, they also fear that any deal to avert them might be even worse for their bottom lines. That is because many of the planned cuts would go to military spending and not just domestic programs, and some of the most important federal programs for states, including Medicaid and federal highway funds, would be exempt from the cuts.

States will see a reduction of $5.8 billion this year in the federal grant programs subject to the automatic cuts, according to an analysis by Federal Funds Information for States, a group created by the National Governors Association and the National Conference of State Legislatures that tracks the impact of federal actions on states. California, New York and Texas stand to lose the most money from the automatic cuts, and Puerto Rico, which is already facing serious fiscal distress, is threatened with the loss of more than $126 million in federal grant money, the analysis found.

Even with the automatic cuts, the analysis found, states are still expected to get more federal aid over all this year than they did last year, because of growth in some of the biggest programs that are exempt from the cuts, including Medicaid.

But the cuts still pose a real risk to states, officials said. State budget officials from around the country held a conference call last week to discuss the threatened cuts. “In almost every case the folks at the state level, the budget offices, are pretty much telling the agencies and departments that they’re not going to backfill — they’re not going to make up for the budget cuts,” said Scott D. Pattison, the executive director of the National Association of State Budget Officers, which arranged the call. “They don’t have enough state funds to make up for federal cuts.”

The cuts would not hit all states equally, the Pew Center on the States found. While the federal grants subject to the cuts make up more than 10 percent of South Dakota’s revenue, it found, they make up less than 5 percent of Delaware’s revenue.

Many state officials find themselves frustrated year after year by the uncertainty of what they can expect from Washington, which provides states with roughly a third of their revenues. There were threats of cuts when Congress balked at raising the debt limit in 2011, when a so-called super-committee tried and failed to reach a budget deal, and late last year when the nation faced the “fiscal cliff.”

John E. Nixon, the director of Michigan’s budget office, said that all the uncertainty made the state’s planning more difficult. “If it’s going to happen,” he said, “at some point we need to rip off the Band-Aid.”

Fernanda Santos contributed reporting.

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Chinese Buoys Focus of Latest Dispute With Japan Over Islands

TOKYO – Japan has asked the Chinese government to explain why Chinese ships have strategically placed several buoys in the East China Sea near a group of disputed islands, a Japanese government spokesman said Friday.

The spokesman, Chief Cabinet Secretary Yoshihide Suga, told reporters that ships from China’s State Oceanic Administration, which is similar to the coast guard, had placed the buoys last week in Chinese-controlled waters near the islands, known as the Senkaku in Japan and Diaoyu in Chinese. The uninhabited islands have been controlled by Japan for decades, but are claimed by China and also Taiwan.

Japanese media reported the buoys might be used to track Japanese submarines in waters around the uninhabited islands, where Japanese and Chinese ships have chased each other in recent months. If so, their placement could represent another step in an ominous escalation in the standoff, which began with coast guard and other non-military ships, but has recently begun to involve more heavily armed navy ships.

Tensions over the islands flared up in September, after the Japanese government announced that it would buy three of the five islands from their private owner, setting off violent street protests in China. The Chinese government responded by sending oceanic administration and other non-military ships into Japanese-claimed waters on almost a daily basis.

Earlier this month, tensions seemed to rise when Japan said that a Chinese navy frigate had briefly used a missile-directing radar to make a target of a Japanese military ship. China has denied doing that.

Mr. Suga did not say how far the buoys were located from the islands. He said they were in undisputed waters controlled by China, but had been placed on Feb. 17 less than 1,000 feet from the edge of Japanese-controlled waters.

He said his government had asked China for an explanation, saying it was also possible that the buoys were being used to track ocean currents or weather. However, the Japanese defense minister, Itsunori Onodera, told reporters that the buoys may be used to track nearby vessels.

The sparring over the islands came as South Korea criticized Japan for sending a top government official to ceremonies highlighting Japan’s claim to another set of islands, which are claimed by South Korea. In a statement, the South Korean foreign ministry said, "We strongly protest the Japanese government’s decision to send a government official to such an unjustifiable event."

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NFL exec: HGH testing resolution needed

INDIANAPOLIS (AP) — NFL senior vice president Adolpho Birch says the league and players association need to reach agreement soon on HGH testing.

The NFL and the union agreed in principle to HGH testing when a new 10-year labor agreement was reached in August 2011. But protocols must be approved by both sides and the players have questioned the science in the testing procedures, stalling implementation.

Speaking at the scouting combine Thursday, Birch says the NFL has full confidence in the test and "should have been a year into this by now." He calls the delays "a disservice to all of us."

On Tuesday, the union said in a conference call it favors HGH testing, but only with a strong appeal process. Otherwise, NFLPA spokesman George Atallah said, "it's just a nonstarter."

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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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Sign of a Comeback: U.S. Carmakers Are Hiring

Tony Dejak/Associated Press

Joseph R. Hinrichs, head of Ford's Americas region, with a two-liter EcoBoost engine at the Cleveland plant.

DETROIT — A few years ago, American automakers cut tens of thousands of jobs and shut dozens of factories simply to survive.

But since the recession ended and General Motors and Chrysler began to recover with the help of hefty government bailouts and bankruptcy filings, all three Detroit car companies including Ford Motor Company have achieved one of the unlikeliest comebacks among industries devastated during the financial crisis.

Now steadily rising auto sales and two-tier wage concessions from labor have spurred a wave of new manufacturing investments and hiring by the three Detroit automakers in the United States. The latest development occurred on Thursday, when Ford said it was adding 450 jobs and expanding what had been a beleaguered engine plant in Ohio to feed the growing demand for more fuel-efficient cars and S.U.V.’s in the American market.

Ford, the nation’s second-largest automaker after G.M., said it would spend $200 million to renovate its Cleveland engine plant to produce small, turbocharged engines used in its top-selling models. Ford plans to centralize production of its two-liter EcoBoost engine — used in popular models like the Fusion sedan and Explorer S.U.V. — at the Cleveland facility by the end of next year.

Its move to expand production in the United States is yet another tangible sign of recovery among the Detroit auto companies. Industrywide sales in the United States are expected to top 15 million vehicles this year after sinking beneath 11 million in 2009.

Last month, G.M. announced plans to invest $600 million in its assembly plant in Kansas City, Kan., one of the company’s oldest factories in the country. And Chrysler, the smallest of the Detroit car companies, is adding a third shift of workers to its Jeep plant in Detroit.

The biggest factor in the market’s revival has been the need by consumers to replace aging, gas-guzzling models. “Pent-up demand and widespread access to credit are keeping up the sales momentum,” said Jessica Caldwell, an analyst with the auto research site Edmunds.com.

And Joseph R. Hinrichs, the head of Ford’s Americas region, explained in an interview that the company’s Ohio revival plan was “all based on increased demand.”

“We’re putting the capacity here because that’s where we need it most,” he said.

Yet even though Ford is enjoying a resurgence in the United States, it is racing to reduce costs in its troubled European division. The workers in Spain who were building the small EcoBoost engines that have been shipped to America will be moved to an assembly plant that is taking on work from a plant to be closed in Belgium.

While Ford survived the industry’s financial crisis without government help, it still cut thousands of jobs and shuttered several factories to reduce costs and bring production more in line with shrinking sales.

But now, the burst of showroom business has prompted automakers to increase output at remaining plants. In Ford’s case, the company added about 8,000 salaried and hourly jobs last year, and has said it plans to hire about 2,200 white-collar workers in 2013. Ford is also moving some vehicle production from Mexico to a Michigan plant, where it will add 1,200 jobs.

The investment in Cleveland is indicative of how Ford and other carmakers have trimmed domestic labor costs and improved productivity since the recession. Just a few years ago, the company was forced to consolidate two engine plants into one in northern Ohio, and close a major component operation. “No question we have been through a lot in northern Ohio,” Mr. Hinrichs said. “But now our North American business is very competitive with the best in the world.”

Mr. Hinrichs said that a new local agreement with the United Automobile Workers union in Cleveland paved the way for the expansion. Currently the plant employs about 1,300 workers.

The Detroit companies are also benefiting from their ability to hire lower-paid, entry-level workers as part of their national contract with the U.A.W. Many of the 450 new workers at the Cleveland plant will start at $16 an hour, compared to about $28 for veteran union members, and some of the new engine plant workers could include employees from other Ohio plants.

“With our competitive labor agreements, we can bring business back to the U.S. from Spain and Mexico,” Mr. Hinrichs said.

Employment still falls far short of levels in the 1990s, when cheap gas and the popularity of S.U.V.’s led to big profits in Detroit.

The auto manufacturing sector employed 1.1 million people in the United States as recently as 1999, according to a recent study by the Center for Automotive Research in Ann Arbor, Mich. About one-third of those jobs were in the final assembly of vehicles, and the balance in the production of auto parts.

Employment dropped as low as 560,000 in 2009. Since then, about 90,000 jobs have been added, the report said.

This article has been revised to reflect the following correction:

Correction: February 21, 2013

Because of an editing error, an earlier version of this article gave a false impression of sales among the Detroit auto companies. Overall auto sales in the United States are expected to top 15 million this year, not sales among the Detroit automakers.

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India Ink: Biswas Nath, the Cycle Shop Owner from Uttar Pradesh

Why do millions of people, from entire Indian villages to urbane middle managers to foreign tourists, brave the crowds at the Kumbh Mela? During this year’s 55-day pilgrimage, to Allahabad, Uttar Pradesh, an estimated 100 million Hindus and others are expected to take a holy dip in the Ganges River to wash away their sins. India Ink interviewed some of them.

Biswas Nath, 38, a cycle shop owner from Brindavan, Uttar Pradesh, was one among them. This is what he had to say.

Why did you come to the Kumbh Mela this year? Is it your first time?

It is my third time. I come with family for a change. We work a lot all the time, so this is a way of taking some time off to visit the deity.

How have you found it so far?

I like it. Have always liked the crowds here. There is so much devotion on their faces.

Describe your journey to the Kumbh. Did you travel alone? How long did it take?

We took the train to Allahabad. It wasn’t a tough journey, though you do tend to get cold on the trains because of these winter nights.

Do you consider yourself a religious person?

I am a religious person. I was also part of an ashram. My cycle shop is just a side business which I do to fill my family’s stomach. Deep within, I am a religious person, closer to being an ascetic.

Who do you think is going to win the 2014 election?

I hope those who are just win. We have suffered enough under incompetence.

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Police: Pistorius detective faces charges himself

PRETORIA, South Africa (AP) — The lead investigator in the murder case against Oscar Pistorius faces attempted murder charges himself over a 2011 shooting, police said Thursday in another potentially damaging blow to the prosecution.

Prosecutors said they were unaware of the charges against veteran detective Hilton Botha when they put him on the stand in court to explain why Pistorius should not be given bail in the Valentine's Day shooting death of his girlfriend.

Prosecutors say Pistorius intentionally killed model Reeva Steenkamp and have charged him with premeditated murder. Pistorius says he mistook Steenkamp for an intruder and that the shooting was accidental.

Police Brig. Neville Malila told The Associated Press that Botha — who gave testimony in the Pistorius bail hearing on Wednesday — is scheduled to appear in court in May on seven counts of attempted murder related to an incident in October 2011 when Botha and two other police officers fired at a minibus they were trying to stop.

Malila said police had learned Wednesday, the same day that Botha appeared in court to oppose Pistorius' bail application, that the charges against Botha and the two others had been reinstated by the Director of Public Prosecutions. They were initially dropped following the shooting incident.

Malila said police were now waiting for details from the Botha case file from the public prosecutor.

Medupe Simasiku, the spokesman for the prosecutors charging Pistorius with premeditated murder, said he couldn't say how the charges against Botha would affect their case against Pistorius.

In the state case against the Olympic athlete, Botha offered often confused testimony and conceded that nothing in Pistorius' account the Steenkamp shooting contradicted the police's version.

Simasiku said that based on the reinstated accusation against Botha, "we can take action and see if we remove him from the investigation or if he stays."

Botha was the lead investigator in an assault claim against Pistorius in 2009. Pistorius' lawyers said police arrested the athlete and held him overnight at a police station and said they will pursue a lawsuit against police for wrongful arrest.

The current case against Pistorius, which is still only in a bail hearing, has riveted much of the world. Pistorius, 26-year-old the man known as the Blade Runner for his carbon-fiber running prosthetic legs, says he fired shots through the locked door of a toilet enclosed inside his bathroom because he thought there was an intruder in there.

Steenkamp was hit three times, in the head, right elbow and right hip, police say, and prosecutors argue Pistorius intended to kill his 29-year-old girlfriend after a fight in the early hours of Valentine's Day.

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AP Sports Writer Gerald Imray in Johannesburg contributed to this report.

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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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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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