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Scott to HHS: Can we talk?

Gov. Rick Scott has requested a meeting with Health and Human Services Secretary Kathleen Sebelius to discuss creating a health-insurance exchange that meets requirements of the Patient Protection and Affordable Care Act.

The exchanges will be online markets where the uninsured can shop for coverage. States can build their own, leave it to the federal government, or develop a hybrid of the two, called a "partnership." That's what Scott said Florida wants to explore.

While his letter takes a conciliatory tone -- he called the law the PPACA instead of the usual "ObamaCare" -- Scott made clear that he does not like it and doesn't think it will accomplish its  goals.

"Current information available to us does not offer any indication that a PPACA exchange lowers health care costs for Floridians," he wrote. He suggested several ideas for cost-cutting that he would prefer.

Scott also put in a plug for Florida's Statewide Medicaid Managed-Care plan, which requires a waiver of federal Medicaid rules in the jointly-financed program. Florida has been waiting on the waiver for months.

His letter came a day after a similar one from Florida's legislative leaders, incoming House Speaker Will Weatherford and Senate President Don Gaetz.  They said they want to explore a partnership-style exchange but can't make decisions on it yet, for two reasons.

They said they have many questions about how the exchange will be set up, and submitted a lengthy list. Other states have had similar questions; HHS is expected to issue a gusher of rules in coming days.

Gaetz and Weatherford also said that Florida's governor and state agencies don't have authority to develop an exchange until the Legislature grants it. They said that can't happen before the next session, which begins in March.

That much of a delay would make it unlikely that an exchange of any kind could be built and ready for operation by the deadline in October.

The Legislature will meet on Tuesday for its organizational session, when the new House Speaker and Senate President are installed. (Editor: An earlier version of this article misstated the day of the session.)

The Affordable Care Act was signed into law 2 1/2 years ago, but Gov. Scott and the Republican-controlled Legislature rejected the idea of implementing it, hoping that either the Supreme Court or election would make it moot.  That didn't happen, leaving Florida considerably behind.

The Act requires citizens to acquire health insurance and provides subsidies for those who can't afford it. Under the Act, the federal government provides funds for states to expand Medicaid to low-income adults who now don't qualify,  but the decision is up to the states.

The major parts of the law take effect in 2014.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.