In exactly a week, the Supreme Court of the United States will begin hearing a legal challenge to the Affordable Care Act (ACA), the health care reform law that was signed in 2010. Leading the challenge in court is the state of Florida.

Since the state first filed a lawsuit against the federal government over the law, legislators in Florida have been waging their own war on President Obama’s health care reform efforts. State officials have (almost) uniformly turned down millions of dollars in public health grants, even though many advocates claim they are needed.

At the end of the state’s Legislative session, Democratic members reiterated their frustration with the state’s continued effort to block funds to which they say Floridians are entitled.

“We are the only state that is doing this,” State Sen. Nan Rich, D-Sunrise, said during the Senate’s passage of a budget that struck millions of federal health grants allocated through ACA. “These funds are coming from our taxpayers.”

Among the many grants turned down recently was $400 million that would have gone to improve Medicaid payments for doctors. Since last year, the GOP-led Legislature and Republican Governor Rick Scott have made significant cuts to the program. The federal government, which still must approve Florida’s plans, has already shot down efforts by the state to levy premiums on Medicaid patients.

Officials in Florida have been very vocal about their dislike of Medicaid spending, which they say will become uncontrollable if ACA is upheld in court. Leaders in the state claim that Medicaid spending is at fault for continued budgetary problems.

During a press conference last December in which Scott announced his budget recommendations, he said that Medicaid spending could “bankrupt the state.”

“No state program has this much growth and costs this much,” he said. “This is absolutely not sustainable.”

Public health advocates, however, have called Scott’s argument misleading. Greg Mellow, of the Florida Center for Fiscal and Economic Policy, told The Florida Independent last year that “any implication that Medicaid spending is spiraling out of control is disingenuous.”

According to Mellow, the projected increase in the state’s Medicaid spending amounts to a “2.6 percent bump for this year.” He said this “is the second smallest percentage increase in the past dozen years.”

One of the provisions of the Affordable Care Act requires that states expand the Medicaid program to more impoverished people without health insurance. The state of Florida has claimed, as part of its challenge to ACA, that the required expansion of the program is unconstitutional.

Among the other provisions, the state is fighting is the creation of state health insurance exchanges (state-operated health insurance databases that allow citizens to shop around for insurance) before the year 2014. According to law, 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 law requires that the federal government come in and create an exchange in place of the state.

The state of Florida has done nothing to even begin planning for the creation of the exchanges as stipulated by the law, which experts warn could compel the federal government to step in.

Officials have said they will begin implementing the law only if the U.S. Supreme Court eventually upholds it.

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