Jim Saunders

In addition to shifting nearly all Medicaid patients to HMOs and other managed care, the Senate's proposal would cap spending, require plans to bid for business and impose $100 fees on patients who abuse the emergency room.

Even though Florida faces a big budget hole, Insurance Commissioner Kevin McCarty said Tuesday the state will forfeit a $1 million federal grant that was supposed to go toward better oversight of health insurance rates.

Florida Republican lawmakers are reviving a proposed constitutional amendment that takes aim at a major part of the federal health overhaul. The proposal, if ultimately approved by voters during the 2012 elections, is aimed at allowing Floridians to opt out of a federal requirement that they buy health insurance or face financial penalties.

Florida Health Choices, a deregulated health-insurance market for small businesses, is two years old and still not selling any products. It would be well-positioned to develop into the exchange called for under the new federal law. But that would require political and philosophical compromises that its leaders may not be willing to make.