It came as a disappointment when last week's health-insurance exchange deadline came and went without Florida getting on board. After the November election, Florida Governor Rick Scott had raised hopes by indicating a new willingness to "have a conversation" about the Affordable Care Act.
This week, though, Scott did something even better when he announced that his state, the fourth most populous in the U.S., will go along with the Affordable Care Act's expansion of Medicaid to cover all residents under 138 percent of the federal poverty line. This is crucial to seeing that more than a million more Floridians get health insurance next year.
In states that do not agree to the expansion, people who earn between 100 percent and 138 percent of poverty will be able to get tax credits to buy insurance on state exchanges. But those below the poverty level who are not now poor enough to be eligible for (unexpanded) Medicaid are to be left in the cold.
So far, about half of states have indicated a willingness to go along with the Medicaid expansion, including now seven that have Republican governors. There is no official deadline for states to come on board.
Only 18 states have so far agreed to build their own insurance exchanges, but this is not as essential to getting more Americans on health insurance. In states that don't build exchanges now, the federal government will do the work, and states are free to cooperate in the effort or even take over their own exchanges as time goes by. Twenty-four states plus the District of Columbia have already agreed to work in partnership with the feds. And "several" more have suggested they will pitch in starting next year, Kathleen Sebelius, the secretary of Health and Human Services, reported in a blog post this week.
Piece by piece the Affordable Care Act appears to be falling into place. Federal officials have assured Congress they are on schedule to set up all the state exchanges by the Oct. 1 deadline. It's a daunting task; let's see how it progresses.
(Mary Duenwald is a member of the Bloomberg View editorial board.)