TALLAHASSEE — Florida already leads a lawsuit challenging the federal health care law, but state officials are going a step further and ignoring the law almost entirely — rejecting millions of federal dollars to provide health care for retirees, seniors, children and people with disabilities.
So far this year, Gov. Rick Scott and the Republican-led Legislature have returned or refused to spend at least $19 million in federal money associated with implementing the health care law. Scott also has stopped any state planning for the creation of mandated health care exchanges, which will allow consumers to comparison shop for health insurance plans.
The decisions put Florida at odds with conservative governors in Texas, Indiana and Wisconsin, who are fighting the constitutionality of the health care law on one hand and planning for it on the other.
The U.S. Court of Appeals for the 11th Circuit in Atlanta is scheduled to hear arguments today in the suit pitting 26 states against the federal government.
"Like a lot of other states, Florida is involved in the lawsuit itself, but there's a big difference," said Eddie Vale, a spokesperson for the Washington-D.C.-based nonprofit Know Your Care, established to educate people about the federal law. "While other states are suing, they are still going ahead with passing regulations that are necessary, working with Health and Human Services where necessary to bring the benefits of the federal health care law to their residents."
Take Wisconsin and Indiana, which are parties to Florida's lawsuit. Governors in both states have signed off on planning for the health care exchanges required by the federal law. In Florida, Scott has not.
Pennsylvania, also part of the lawsuit, has 2,684 residents signed up for a program that provides low-cost health insurance to people with pre-existing conditions, such as cancer and diabetes, who can't buy coverage anyplace else. Pennsylvania runs its own program with funding from the federal government and has more enrollees than any other state.
In Florida, only 770 people are enrolled in the same plan, and the state has declined to run its own program.
Texas has accepted $276 million for a program that provides health insurance to people over 55 who have retired but aren't yet eligible for Medicare. Much of that money is going to Texas state employees.
Florida, by contrast, has accepted only $15 million for the early retirement program — with local governments taking the money. Scott is planning to accept $37 million for the program, but that was because the payout was agreed to by former Gov. Charlie Crist, officials said.
The issue in Florida isn't necessarily over the money, it's the portion of the federal law that requires people to buy health insurance or pay a tax penalty. That requirement is to take effect in January 2014.
Florida filed suit challenging the constitutionality of the so-called "individual mandate" provision moments after President Barack Obama signed the act into law in March 2010, arguing that the government can't force people to buy a product.
Twenty-five states joined the lawsuit, along with the National Federation of Independent Business.
A federal judge in Pensacola ruled in January in favor of Florida and the other plaintiffs, concluding that because the mandate is unconstitutional, the entire law is unconstitutional.
The case is expected to be decided by the U.S. Supreme Court. Scott has said he has no plans to implement the federal law until after that decision.
With that in mind, he returned a $1 million grant that would have helped pay for a system that would allow consumers to monitor insurance rates.
And the Legislature stiff-armed seven federal grants this year worth more than $17 million available through the health care law.
The rejected money included $2 million for hospice care for children, $8 million for construction of community health centers and a first installment on a five-year, $35.7 million grant through the Money Follows the Person program.
The program, created in 2005 under President George W. Bush, aims to keep elderly and disabled people out of nursing homes by providing home health aides and other services. The grants save states money because Medicaid usually pays if clients stay in nursing homes.
Advocates for the aging are alarmed by the decision to reject the money.
"Florida needs every dollar it can get to delay the growth of nursing home usage,'' said Larry Polivka, director of the Claude Pepper Center, a Tallahassee think tank on aging. "This started with Bush. It's a Republican program, for God's sake.''
The Legislature also discontinued a federal grant that helped poor people get a break on their Medicare costs. Various programs pay Medicare's premiums, copayments and deductibles and can save people $1,000 to $3,000 a year. The problem is getting the word out. Many people don't know they qualify.
Over the past 18 months, the Area Agency on Aging of Pinellas and Pasco counties said it helped 1,400 people apply for the subsidies. Potential savings top $4 million a year, the agency estimates. Without a grant extension, the program will shut down.
House Speaker Dean Cannon decided well before the legislative session started not to implement the law, sending out a call to state agencies in October to determine how much money and time had already been spent on its programs.
"For all the grant money, it boiled down to simple principle: We were not going to be hypocritical," said state Rep. Rob Schenck, R-Spring Hill, chair of the House Health and Human Services Committee. Schenck said it would be odd to fight the health care law and work to implement it at the same time.
Legislators also plan to ask voters to amend the state Constitution next year to ban "laws or rules from compelling any person or employer" to buy health insurance. The measure, which needs approval by 60 percent of Floridians, would not stop the federal law in Florida if it survives a court challenge. But supporters say it would at least ban similar programs at the state level.
Meanwhile, activists in Florida are working to let people know what aspects of the health care law are in place, regardless of state roadblocks.
"It's easy to maybe conclude that implementation is not happening in Florida, but the fact is it's happening," said Patrick Cannon, a spokesman for a group called Florida Community Health Action Information Network. "It's been happening because there are so many aspects of the law that have nothing to do with the state."
The limited pre-existing condition insurance program is just one example.
"People can take advantage of a lot of these benefits now." Cannon, who is not related to the speaker, said. "And they might not be aware of it."
Times staff writer Stephen Nohlgren contributed to this report. Janet Zink can be reached at firstname.lastname@example.org or (850) 224-7263.