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Tallahassee, Fla. - Health care advocates in Florida are urging the federal government to consider operating Florida's new health insurance exchange because the state is so far behind setting it up.

The Affordable Care Act requires states to have online health exchanges where people can shop for health insurance. That part of the federal health care law takes effect in January, 2014.

Gov. Rick Scott and Republican legislative leaders have adamantly opposed the law since its inception and blocked its implementation over the past two years. The Obama administration has distributed more than $2 billion to states to help them prepare exchanges, but Woodall says Florida has not collected any of the cash.

Now about 20 health advocacy groups across Florida have sent a letter to Health and Human Services Secretary Kathleen Sebelius, asking her to put the feds in charge of Florida's exchange in 2014 and 2015 if the state can't draw up a viable plan soon.

Advocates are concerned Gov. Scott's past opposition means he won't work hard to develop an effective exchange, and might try to make it fail.

"The best option is for the feds to run the exchange initially and then for Florida to move forward because we're behind the eight ball," said Karen Woodall of the Florida Center for Fiscal and Economic Policy. "We haven't done what needs to be done to have an effective exchange and this affects millions of people. And it's too important to rush into quickly because all of a sudden, now people have realized it's an important measure."

Now Gov. Scott and legislative leaders are softening their opposition to the law because they want some control over how it's managed in Florida. They acknowledge the ACA is the law of the land and they're reaching out to the feds to talk about the issue.

Gov. Scott has sent a letter to Secretary Sebelius, asking questions about how the exchange will take care of Florida families.

"How is this going to help us reduce our health care cost? How is it going to make sure we have great quality? How is it going to give us good access to health care? That's what the focus of this ought to be and that's what the focus of these exchanges ought to be," said Scott.

Woodall says health advocates are thrilled to see that the governor and other state leaders are now talking with the feds. She says it shows they recognize that the exchange will be very important to many Floridians.

It's estimated up to half of Florida's 4 million uninsured people could get new access to health insurance through the program.

But Woodall remains concerned Florida's lack of preparation on an exchange could pave the way for confusion, and wasted time and money, if the state gets too much control over the exchange in the short-term.

"We cannot possibly have a fair exchange and effective exchange set up by 2014 given how far behind we are. That's the message. We want to work together. We think everybody can come to the table and work with the feds and move into a state-federal partnership down the road. We're just not there right now."

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