TALLAHASSEE -- In the months before he became Florida House speaker, Marco Rubio crisscrossed the state searching for ways to make Florida better.
The best proposals, dealing with topics ranging from property taxes to education, became a book: 100 Innovative Ideas for Florida’s Future.
Chapter 8 is titled “Quality Healthcare at an Affordable Price,” and it includes Idea No. 87: “Florida should launch a marketplace of affordable health insurance.”
Why is any of this important now, more than five years later?
While Gov. Rick Scott has said Florida will refuse to participate in optional provisions of the federal health care law, including the creation of a state health insurance exchange, Rubio’s vision for an insurance marketplace is about to come to fruition.
It’s called Florida Health Choices.
And though Republicans such as Rubio and Scott won’t admit it, Florida’s marketplace is a lot like President Barack Obama’s exchange.
“It’s about competition, it’s about choice, and it’s about the marketplace,” Rubio told the Palm Beach Post in 2008. (Rubio didn’t respond to questions for this story.) “It’s a priority of the House, and it needs to be respected and considered.”
Florida Health Choices is scheduled to launch later this year and is currently in the process of signing insurance companies and agents up for the program. Small businesses with four to 50 employees will be able to participate and coverage will begin in 2013.
Although Republican lawmakers like to play up the “marketplace” description of Florida Health Choices, it is set up like a health exchange. Like an exchange, it is a Web-based portal where people can shop for health insurance. And like an exchange, it is intended to create more options in hopes that more people will purchase coverage.
The exchanges, however, must be open to a wider range of individuals and have minimum coverage standards. The health care law, which first passed in 2010 and was upheld by the U.S. Supreme Court last month, also creates subsidies to help people afford insurance and penalties for people who don’t obtain policies through exchanges or other options.
In Florida, lawmakers have the option of creating an exchange, altering its marketplace to comply with the law or partnering with the federal government to create an exchange. The state can also do nothing and allow the federal government to create an exchange for the state.
Top Republicans in the Legislature said they wanted to take the time to study their options in light of the Supreme Court ruling.
But Scott made up his mind relatively quickly. Just 36 hours after the ruling, he went on Fox News and announced Florida would not set up an exchange and therefore continue to reject millions of dollars in federal grants. Scott’s communications director Brian Burgess said the governor’s complaint is about how health exchanges are forced to operate.
“It’s one thing to set up an exchange, but when you set it up under the rules that Obamacare requires there is no way it reduces cost of insurance,” Burgess said. “The point is, in the governor’s experiences, these exchanges don’t keep the costs low for the people who may need to buy it.”
Rubio also remains a vocal opponent of the law, giving critical remarks on the Senate floor the day of the ruling. A spokesman for Rubio said the differences between health exchanges and Florida Health Choices are problematic.