Recently, I hadan opportunity to attend a luncheon where Florida Governor Rick Scott gave the keynote addres s. He was surprisingly bright and certainly on top of things here in our sunny state, which has suffered a few economic kicks in the head over the past few years. He spoke on myriad issues and provided a number of positive statistics that indicated his short time in office has been a success. Unemployment is going down, while tourism is going up. Each topic was one of importance, but I was particularly interested in hearing what this first-time politician had to say about Florida's current position on health care reform.
Under Scott's leadership, Florida is one of many states challenging the Patient Protection and Affordable Care Act on the basis that the individual mandate provision of the law is unconstitutional. But with the 2014 effective date of the provision fast approaching, Florida is one of just a few states that have not yet begun setting up its mandatory state-run health insurance exchange.
So, I made sure my question to the governor made it to the top of the pile: "What is Florida's current state of compliance with the Affordable Care Act?" Surprisingly though, my question was not addressed. In fact, health care reform wasn't mentioned at all. Perhaps Gov. Scott was simply abiding by age-old advice from his mother: If you don't have anything nice to say, don't say anything at all. Or maybe he's likened himself to the mighty ostrich and has his head firmly planted in the sand. Or perhaps he's convinced himself that if he doesn't acknowledge PPACA, it won't exist.
As a benefits professional, I easily could be tempted to try all of the above. But regardless of my personal feelings, PPACA not only exists, it has been the law of the land since March 2010. So what gives, Governor?
In reality, the governor probably kept quiet on the subject to avoid commenting on a matter currently in active litigation. At a recent editorial board meeting for a local newspaper, Scott was quoted as saying that the health care overhaul was "not the law of the land." Further, no enabling legislation has been passed in Florida that would allow the state to begin creating the required insurance exchanges that must be in place by 2014. Additionally, the state has turned away all federal funds and grants associated with implementing PPACA.
This has created an interesting conundrum for state employers that provide medical coverage to their employees. I haven't met anyone in the benefits business that isn't working at a "full steam ahead" approach to PPACA compliance. We've all welcomed young adult dependents into our plans up to and including the month during which they turn 26; we've amended our summary plan documents to ensure preventive care is covered at no cost to plan participants and that no pre-existing provisions apply where they shouldn't. We've obsessed about keeping our slate of benefits modest enough to avoid the possibility of being considered "Cadillac" in the years to come. We've even enjoyed receiving a few dollars from participation in the Early Retiree Reinsurance Program.
But Gov. Scott has remained steadfast in denying the sovereignty of PPACA, and his denial is rooted in firm legal footing following a ruling by a U.S. district court in Pensacola last year that the law is unconstitutional. The ruling was centered on the premise that the law overreaches with the individual mandate. This is an interesting position, considering that Florida mandates residents to purchase auto insurance, but I'm sure someone more scholarly than I could debate the differences between those two issues.
We're all watching with interest as the Supreme Court prepares to settle the matter once and for all. Personally, I hope the justices rule before the end of June. If so, Florida will have the opportunity to apply for federal funding, since the deadline for state applications has been extended to the end of June. The funds will come in handy, as Florida is not exactly rolling in dough these days and even the folks at the Department of Health and Human Services have conceded that there will be substantial cost involved in setting up the exchanges.
But even if the final ruling is made in June, or even before then, I can't help but wonder how Florida will get all its ducks in a row in time to be fully compliant by 2014. Not to disparage the industry I've chosen for my life's work, but my experience in government has been that things don't get done quickly. If I were the governor of this great state, I think I'd take a concurrent approach to compliance and litigation. But some sources speculate that Florida will not comply with PPACA and set up the exchanges even if the Supreme Court rules that the law may stand. It is even possible at this point that a federal exchange will ultimately serve the people of Florida (and our rogue neighbors in Louisiana, which has adopted a similar hard line against PPACA).
As for how it all will end, opinions vary. When you throw a presidential election into the mix, the politics of PPACA become downright theatrical. If I were a betting girl, a matter as complicated and unpredictable as this one would almost assuredly cause me to stop betting.
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.
