TALLAHASSEE — The state that launched a two-year legal challenge to the federal health care law isn't sure what it will do now that the law has been upheld by the U.S. Supreme Court.
Florida Gov. Rick Scott, who dipped into his personal fortune to campaign against passage of the health care law and, after being elected, refused to implement it, told reporters Thursday that he would need time to decide his next move.
"I've got to read through the decision and make sure we understand it," Scott said.
Attorney General Pam Bondi, who sat in the front row during March oral arguments and became a national face of the lawsuit, said she was "surprised, shocked," by the ruling.
Scott could decide to embrace the Patient Protection and Affordable Care Act now that Florida's legal challenge has been rejected. But he and Republican lawmakers also could continue to resist, in hopes that Congress or a new president repeals some or all of the law.
Several parts of the law require state cooperation starting in 2014, but Florida so far has taken little action. The state has not set up a health exchange and has rejected or refused to pursue tens of millions of dollars in federal health care funding.
"Sadly, we're behind years at this point," said Rep. Mark Pafford, D-West Palm Beach, the ranking member on the House Health Care Appropriations Subcommittee. "We have not done anything that would indicate to anybody that we've even attempted to move in the direction of what the law in the land is."
Mark Wilson, president of the Florida Chamber of Commerce, said that's okay. There is no sense in embracing the law until Thursday's ruling is fully understood and the politics of the elections are allowed to play out, he said.
The state is doing some things, including trying to launch an "insurance marketplace" that is similar to a health exchange. The program would need to be altered, however, to meet requirements of the health care law.
Florida also is spending millions to develop an Internet-based Medicaid eligibility system to make it easier for state agencies to communicate with each other and the federal government. That could in turn make it easier for the state to handle an influx of new Medicaid patients, if the state decides not to opt out of the proposed expansion.
That's a big if. The law includes a provision that states extend Medicaid coverage to people under age 65 with incomes up to 133 percent of the poverty level, or just under $30,000 a year for a family of four. The Supreme Court upheld the expansion but said the federal government could not compel states to comply by cutting off the federal money they receive for existing Medicaid programs.
Such an expansion could add more than 950,000 people to Florida's Medicaid rolls and eventually cost the state billions.
The federal government will initially pick up all the additional costs, but eventually the states would be on the hook for about 10 percent of the tab — and Florida is strapped for cash in part because of high Medicaid costs.
State Sen. Joe Negron, R-Stuart, who chairs the Senate committee that oversees health care spending, said whether or not Florida agrees to the Medicaid expansion won't likely be addressed until the Legislature convenes next spring.
"Are we going to accept the additional funds and increase our Medicaid rolls by 50 percent and under what terms will we do that?'' Negron said.
Supporters of the health care law point out that the increased spending is a small fraction of what the state is already paying for Medicaid, and the expansion's goal is to reduce the number of uninsured Florida residents while driving down overall health care costs.
However the state decides to move forward, lawmakers already have placed a constitutional amendment on the ballot that would prohibit individuals or employers from being forced to obtain health insurance or from being penalized for not doing so.
The ballot initiative, which needs 60 percent support to pass, is unlikely to have any real impact, however, because federal law supersedes state law. But it could bring the state and federal governments back together in a courtroom, a battle that Senate President Mike Haridopolos welcomes.
"I think the voters of Florida will support that measure, and I think it's the right thing to do," Haridopolos, R-Merritt Island, said.
Scott, a former owner of a chain of hospitals, started his political climb in 2009 when he formed Conservatives for Patients' Rights, a group that opposed the health care law.
He then led the fight against it in Florida with Bondi, who continued the lawsuit filed by former Attorney General Bill McCollum.
"We cannot lose sight of what we accomplished," Bondi said. "We fought for the principle that the Constitution's limits on Congress are very real, and they affect the lives of people, and on that point we won."
Times/Herald writers Steve Bousquet, Mary Ellen Klas and Brittany Davis contributed to this report, which included information from the News Service of Florida.