Kaiser Health News and The Washington Post report that the “pressure is growing on the federal government” to create health insurance exchanges for states falling behind in implementing the federal mandate, as well as states that are “flat-out” refusing to create exchanges — such as Florida.

States will have to prove to the federal government by January 2013 that they will have a functioning state exchange by 2014. If they cannot, the Affordable Care Act requires that the federal government come in and create an exchange in place of the state.

Kaiser and the Post report:

All but a few states accepted initial federal planning money for exchanges, and 28 of them plus the District of Columbia have received additional grants.

About a dozen have authorized establishment of exchanges, but even those may not be able to meet the deadlines for enrollment. Alaska, Florida and Louisiana have said flat out that they won’t establish exchanges of their own.

That guarantees that a federal exchange will be needed. But those crafting it face enormous technical, political and financial challenges.

Gov. Rick Scott has said he does not believe the health care reform is “the law of the land,” and will not implement it until the U.S. Supreme Court decides to uphold the law. PolitiFact ruled that Scott’s statement was completely false.

During a town hall hosted by Florida health advocates this past November, Anton Gunn, the regional director of the U.S. Department of Health and Human Services, expressed frustration with the state for falling so far behind in implementing mandates from the law. Mostly, he said, Florida is acting as if Affordable Care Act is not currently in place.

So far this year, state legislators have not held any meetings to discuss creating an exchange, and there is no law introduced for the upcoming session that would set up an exchange.

The Florida Center for Fiscal and Economic Policy released a report a couple weeks ago warning state officials that delaying implementation of federally mandated health policy changes could “compound” the challenges they might already face.

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