The Florida Center for Fiscal and Economic Policy (FCFEP) released a report this month warning state officials that delaying implementation of federally mandated health policy changes in the state could “compound” the challenges they might already face.

According to FCFEP’s website, the group conducts independent research and they “advise policymakers on state fiscal and economic policy.”

One of the issues that FCFEP has payed particular attention to is the state’s refusal to move forward with mandates that are part of the Affordable Care Act, the 2010 health care reform law signed by President Obama.

This month, the group released a report (.pdf) that highlights some of the bigger drawbacks of the state’s inaction.

As of now, Florida remains one of only a handful of states turning back federal grants meant to aid the state in the creation of a health insurance exchange program. This signals that the state is not even in the early stages of planning.

“Only 26 of the original 45 months of the implementation ‘race’ remain,” the groups says in their report , “and Florida has yet to start its engine. The governor’s and legislature’s continued resistance to the ACA and the resulting delays have dimmed Florida’s prospects for successfully crossing the finish line.”

The report says this makes “an already difficult process even more challenging.”

According to the report, “the list of tasks to be completed for implementation is extensive, including overall policy direction-setting by the legislature, detailed program analysis and planning among multiple state agencies, development of new infrastructure, selection of vendors and insurers, adoption of new laws, rules and forms, and testing and launch of the new system.”

As required by law, by 2014, the state has to have created and prepared for the establishment of one or more health insurance exchange programs, expanded the state’s Medicaid program and prepared for the reform of health insurance policies in the state. According to FCFEP, “this includes both protections for consumers and new requirements of insurers, whether providing coverage inside or outside of an exchange.”

FCFEP reports:

Implementation of all three components will require significant policy-making, planning, resource allocation and infrastructure development on the part of the state. States regulate most aspects of health insurance coverage sold to individuals and small businesses. States administer their own Medicaid programs, subject to federal laws and regulations that ensure minimum standards are met. States are charged with establishing and operating their own health insurance exchange, although they may turn that down.

This leaves 45 months – less than four years – for states to complete this work. For that reason, many states began implementation almost immediately. Although the form and pace of implementation differs from state to state, Florida is by all accounts one of only two states taking no action whatsoever to implement the key components of the ACA.

However, the group says there is still enough time and that “the 26 months that remain should be sufficient for Florida to complete the tasks associated with implementation.” However, the group warns, ” the challenges will compound as time continues to slip away. ”

Furthermore, “both the governor and the legislature have yet to signal any receptivity to the ACA whatsoever,” the report points out.

Last week, Gov. Rick Scott went as far to say that he did not believe the health care reform law was “the law of the land.” He also said he would implement the law if the Obama administration wins the legal challenge (led by Florida) being heard in the Supreme Court next spring. Some estimate that a decision could be reached next summer — leaving Florida with even less time to plan and implement the law if it is upheld.

A constitutional law professor recently said that if Scott’s position is that health care reform is not the law of the land, “then he is violating his oath of office.”

Even though health care reform advocates have stood by the law and criticize state officials for stalling its implementation, new polling suggests a majority of the public dislikes the law. Most are unaware of what is in the law and want Congress to keep or expand the law, ABC reports.

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