Just a week after the re-election of Barack Obama ended all Republican hopes of overturning the new health care law known as " Obamacare," Gov. Rick Scott and other Florida leaders who have steadfastly rejected the idea are now willing to at least talk about implementing it for the state's 3.8 million uninsured.
" Mitt Romney did not win the election," Scott told reporters Friday in Washington D.C., hours before he released a letter to Health and Human Services Secretary Kathleen Sebelius asking for a meeting to discuss implementing the law. "So it's not an option to repeal Obamacare. So my goal now is: focus on what's good for our citizens."
He added: "The official response is going to be: 'I want to sit down with you. I want to see how we can work together to lower health care costs for Floridians.'"
But it will be some time before Florida decides on how to implement crucial elements of the Affordable Care Act: setting up an insurance "exchange" and adding lower-income Floridians to the Medicaid program.
Incoming House Speaker Will Weatherford and Senate President Don Gaetz wrote Sebelius Thursday night saying they could not yet make a call on whether to start an exchange — essentially, a state-run health insurance marketplace for small businesses and individuals.
The law says that if a state refuses to set up an exchange, the federal government will do it. So far, 13 states — mostly Democratic — and the District of Columbia have officially said they will run their own exchanges.
Weatherford and Gaetz wrote that 100 rules and regulations are still being developed by the Obama administration, including guidelines on minimum coverage and benefits. And in his letter Friday, Scott said startup costs "are projected at $92.3 million" through next year, and annual operating costs to the state – based on experience in Illinois -- could range from $57.4 million to $88.6 million by 2016.
"We should be looking out for our consumers and we should be looking out for our state and doing what's best for them," said Weatherford, R-Wesley Chapel. "The problem is there are hundreds of unanswered questions that are out there with regard to the implementation to the Affordable Health Care Act. Until we have the answers to those questions, we don't know which plan gives our consumers the most choices."
Insurers are researching and trying to develop plans that work with the new requirements, but they too have a lot of questions, said Michael Garner, executive director of the Florida Association of Health Plans, a trade association for health insurers. They haven't even figured out if it's better for the federal government or the state to run the exchanges, or some sort of partnership.
"Until we get more information, it's too difficult to stipulate which direction is best," Garner said.
The federal government counters that states have been offered help in getting the process started, and the deadline to decide on who should run the exchange has been extended from last week to Dec. 14. HHS has provided a blueprint of what a state exchange should look like and offered grants to pay design costs. Florida applied for the money in 2010 under Gov. Charlie Crist, but Scott ordered the state to return the $1 million check.
The exchanges are a crucial key to the health care overhaul, which by 2014 will require all adults to either purchase health insurance, enroll in a federally subsidized plan — or pay a tax.
Large employers will be required to provide health coverage to employees or pay a fine. Smaller companies, of up to 100 employees, and individuals not covered by an employer would find insurance using the exchange, and lower-income purchasers would qualify for federal subsidies. Plans offered by the exchanges would provide a minimum level of benefits, with limited co-payments and out-of-pocket expenses.
The exchanges must begin enrolling users by October 2013 and be fully operational by Jan. 1, 2014.
Both Weatherford and Gaetz have said they want the Legislature to decide whether the state or federal government should run the insurance exchange, and whether Florida should expand its Medicaid program to cover an estimated 800,000 to 1.3 million low-income individuals who currently earn too much to qualify. In upholding the law in June, the U.S. Supreme Court said states could not be compelled to expand Medicaid eligibility.
Though the feds will pay 100 percent of the cost of the new enrollees, that will drop to 90 percent by 2020. Scott has said the state can't afford the expansion of Medicaid, which state analysts have pegged at about $1 billion but which Scott insists is likely to be higher.
Scott also is seeking federal approval
to put the state's existing Medicaid patients into managed care — like HMOs — under a cost-cutting proposal passed by the 2011 Legislature. "Statewide Medicaid managed care is one way we can act immediately to encourage more competition in health care which would drive down costs and increase outcomes and services,'' he wrote in his letter to Sebelius.
Gaetz said he and Weatherford have asked legislative staff to engage with HHS staffers about what their options are.
"It's a law, and it's a constitutional law," Gaetz said. "There's a ruling on the question. It is my constitutional duty to implement the law, and I will do it."
One option the Florida Legislature will look at is converting Florida Healthy Choices or Florida Healthy Kids into an insurance exchange that meets the health care act's requirements.
Florida Healthy Kids, which was created in 1990, has covered more than 1 million low-income children from families who don't qualify for Medicaid. Most families pay nothing for the insurance.
Florida Health Choices, created by the Legislature in 2008, is an online marketplace of insurance plans that will function like an exchange — but without the minimum benefit requirement. Rose Naff, chief executive officer of the group, said she hopes to be fully operational this spring.
When its website opens, Florida Health Choices will allow employers to enter where the company is based, the number of employees and the birth dates of all its employees. The site will generate a list of available insurance plans, showing monthly premiums as well as deductibles, copays and other benefits.
Staff Writers William Gibson and Aaron Deslatte contributed to this report.