“He thinks the right approach is what Florida did in 2008 where he set up a marketplace where businesses can buy health insurance as part of the free market,” Rubio spokesman Alex Conant said. “Obama’s approach is very different. It forces businesses and individuals to buy government-approved health care or face a new tax.”

So far, the nation’s major insurance companies have not chosen sides. For example, a Humana executive serves on Florida Health Choice’s Vendor Steering Committee and the company has also worked to implement the Affordable Care Act.

Liz Calzadilla-Fialo, UnitedHealthcare’s regional director of public relations, said the company is remaining open.

“At this time, we are simply monitoring all discussions around the establishment of exchanges in Florida,” she said. “It’s simply too premature to tell what will actually materialize and how we will engage. Therefore, for the time being, we are monitoring and assessing all possible options.”

The state must present a plan to the federal government by Nov. 16 if it wants to run its own Affordable Care Act-compliant health exchange. If it does not, the federal government says it is prepared to step in and create the exchange itself.

“Consumers will have the option to compare prices and coverage and get to the insurance that so many of them need,” said Paul Dioguardi, director of intergovernmental and external affairs at the U.S. Department of Health and Human Services. “At the federal level, we’re moving full steam ahead with implementing the changes and we’ll be ready to go to make sure that consumers will be able to benefit through them.”

Consumer organizations that supported the Affordable Care Act have resigned themselves to the idea of the federal government operating a health exchange in Florida. Now they are urging the state to cooperate, even if it doesn’t want to participate.

The state should end its “stonewalling,” said Laura Goodhue, executive director of health care advocacy organization Florida CHAIN.

“There are discussions that need to happen between coordinating with our agencies and the federal government,” she said.

Initially, Rubio’s Florida Health Choices also had its share of detractors.

The public-private corporation got off to a slow start because of resistance from former Gov. Charlie Crist, who along with state Democrats argued the program was using state funds to create another level of bureaucracy between health care and the people who need it.

Crist was slow to appoint members to the board, and Florida Health Choices didn’t get a chief executive officer until Rose Naff was hired in 2010.

As Naff leads the efforts to launch the marketplace, the Affordable Care Act is simply not a part of the equation, she said. That is because everything the program is allowed to do is specifically outlined in statute and can only be altered by the Legislature.

“We have a statutory assignment to do a marketplace,” Naff said. “We have to fulfill that mission. If someone wants to change our mission, it requires a change in law.”