Ever since Congress passed the Affordable Care Act in 2010, the state of Florida has done everything it can to fight the law. It filed suit to block the law's implementation, leading to the dramatic Supreme Court decision this summer in which the court upheld most of the law but allowed the states to decide whether to accept the expansion of Medicaid contained in the bill. The state legislature in 2011 passed a constitutional amendment trying to block the individual mandate, which was rejected by voters last month in a ballot initiative.
State leaders, among them Republican governor Rick Scott, seemed so sure that they’d prevail in their legal cases that they never took any steps to begin preparing for the law's implementation, namely the creation of an online "exchange," that will serve as a regulated marketplace for individual insurance policies that can be bought by people eligible for federal subsidies. The state has to tell the US Department of Health and Human Services by December 14 whether it will set up its own exchange or punt and let the feds do it for them. The decision is proving contentious.
On Monday, the state Senate held the first public hearing on the ACA implementation, which drew a rowdy crowd of tea partiers intent on getting the state to simply defy federal authority and refuse to implement the law. CBS Tampa Bay reports:
A rowdy conservative crowd commandeered a nearly hour-long public comment section, stressing that the constitution does not grant the federal government the authority to make health care decisions, despite a U.S. Supreme Court ruling that upheld most of the health care law. All but one spoke against "Obamacare".
"We will not comply with this unlawful mandate," Pastor James Hall of the Baptist Coalition of North Florida said to rousing applause.
Constitutional attorney Krisanne Hall said she travels the country talking to citizens and religious groups who echo that sentiment. She asked the Senate committee to consider how it will deal with citizens "when they lawfully and constitutionally stand and say we will not comply."
Democratic Senate Minority leader Chris Smith was booed when he reminded the crowd that the federal government stepped in to uphold justice in civil rights cases.
Consumer advocates are worried about the state's ability to get the job done and to create an effective exchange. Last week, they appealed to Health and Human Services Secretary Kathleen Sebelius to conduct a "reality-based assessment" of any state exchange proposal, and asked federal officials to force Florida to default to a federal exchange if there was even the slightest indication that the state's plans looked subpar. They note that the state has not created any mechanism for input from consumers in the development of the exchange, and that its history with a Medicaid privatization plan does not give much confidence that the state will be looking out for citizens' best interests.
"Our hope is that eventually Florida will be in the position to develop its own high quality health insurance exchange with consumer input—but we are in no way ready for that now," said Laura Goodhue, of FL CHAIN, a nonprofit advocacy group that focuses on access to health care. "Florida just waited too long to make this happen by the deadline. Now we ask the state to fully cooperate with the feds to make sure Floridians have access to affordable coverage as the law intended."