And though Florida declined to accept $51 billion in federal funds over 10 years to expand Medicaid, which could have covered more than 1.1 million uninsured people, the cuts continue.
Over the next decade, funding for disproportionate share hospitals will be reduced by hundreds of millions of dollars per year, beginning with a scheduled $500 million nationwide reduction for the year ending October 2014.
The health law faces other tests as well, such as whether the projected seven million uninsured Americans will enroll for subsidized health insurance during the open enrollment period on the exchanges that begins Tuesday and ends March 31.
Another unanswered question is what effect if any the health law will have on the majority of individuals who get health insurance through an employer.
About 68 percent of Americans aged 18 to 64 in 2011 received employer-provided health coverage, and they do not need to enroll through the exchange unless they spend more than 9.5 percent of their annual income on health insurance and pay more than 40 percent of their total medical costs. Americans older than 65 who are covered by Medicare do not need to enroll.
But while Americans with employer-provided health insurance are not supposed to see any change in their coverage or rates due to the health law, that does not mean their employer cannot make a change.
In the past decade, many employer-provided plans have reduced benefits and raised costs for consumers whether through the increasing use of co-insurance plans with high deductibles, or smaller provider networks that offer fewer choices of specialists and physicians.
Sal Barbera, a former hospital executive who teaches healthcare administration at Florida International University, said he will be watching to see whether the Affordable Care Act lives up to the promises made by the president and the laws proponents.
It will be interesting to see, when the dust settles, what does this all mean for consumers in regards to price of healthcare, the accessibility, Barbera said. A lot of people still remember the president telling everybody that if youre happy with your insurance, you can keep it. Is that really true? I dont know the answer to that.
Insurance companies must guarantee coverage to all individuals, regardless of pre-existing conditions, for plans beginning in January. They are no longer allowed to charge higher rates based on gender, and they can only charge their oldest and sickest members three times the amount they charge their youngest and healthiest members.
Those regulations are likely to drive up the cost of insurance for everyone, according to officials with Floridas Office of Insurance Regulation.
Another potential challenge for the laws success: Young people who rarely use medical services may choose to pay a penalty starting at $95 or 1 percent of income but escalating after the first year rather than buy health insurance.
Results of a Gallup Poll released Monday found that a majority of uninsured Americans, about 65 percent, plan to buy health insurance rather than pay the fine. Twenty-five percent said they would pay the fine.
Almost half the people polled by Gallup, 48 percent, said they planned to use the health insurance exchanges to shop for coverage; 17 percent were uncertain, and 36 percent said they would not.