After the Supreme Court upheld the so-called individual mandate and substantially all of the Patient Protection and Affordable Care Act following a legal challenge led by my home state of Florida, President Obama hadn't finished his victory lap before the political line was drawn in the sand. The battle is over, but war wages on until the American people take to the voting booth in November. I have a feeling this election year will be an interesting one, and with a front row seat in Florida, I'm going to be tuned in and transfixed.

For those of us charged with the responsibility of managing employer-sponsored health plans, the Supreme Court ruling has resolved some unanswered questions. By now, most benefit managers have read the opinion with a collective nod and have gone back to the business at hand. But I have the unique privilege of living in Florida, after all; so, it would seem inevitable that we would see some scrambling in Tallahassee as Governor Rick Scott comes to terms with the ruling.

Surprisingly, however, Scott remains defiant even after the ruling. Within 48 hours, he announced publicly that he will not take any steps to implement any portion of PPACA that is not required before it takes full effect in 2014. His defiance will continue until at least November, with the hope of a Republican victory that would recapture the White House and gain a sizeable enough Republican congressional majority to repeal the law.

Florida has declined more than $100 million in PPACA-related funding to date - what's a few more dollars? The Supreme Court has clarified that the state expansion of Medicaid is optional; so, at least for now, the governor has stated he'll decline. Meanwhile, Florida's population remains more than 20% uninsured.

Despite that staggering percentage, Scott has publicly stated his frustration with Medicaid is rooted in the many governmental strings attached to the federal money the state receives to maintain the program. He's long been an advocate of the federal government sending Medicaid funding in the form of a block grant to be managed as the state deems appropriate (a concept embraced by many Republicans and opposed by just as many Democrats). There's little doubt that his reluctance to embrace expanded Medicaid under PPACA in the wake of the Supreme Court ruling probably lies somewhere in the inevitability that more funding will bring more strings attached.

Despite the political spotlight shining very brightly on Florida yet again, Palm Beach County (and every other Florida employer I'm aware of) is working in compliance with the PPACA. But with November looming, the landscape has the very real potential of changing yet again with the possibility of a new president (ironically, a candidate who penned the Massachusetts prototype to PPACA).

So, even in the wake of the Supreme Court ruling, it isn't over until the fat lady sings (and learns to comply with her employer-sponsored wellness program).

Contributing Editor Nancy L. Bolton is the director of risk management for the Palm Beach County Board of County Commissioners in West Palm Beach, Fla.

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