http://www.floridavoices.com/topic/health-carehttp://www.tallahassee.com/article/20120723/OPINION05/307230006/J-Robert-McClure-Florida-takes-prudent-path-health-careIn many a medical office, a worried patient — surprised by an unwelcome diagnosis after a series of grueling tests — has turned to the doctor and plaintively asked, “What now?”The same question undoubtedly occurred to millions of Americans after the U.S. Supreme Court’s ruling on Obamacare — or the Affordable Care Act (ACA) as it is known. That 2010 law had been diagnosed as ailing during a series of lower-court exams, but Chief Justice John Roberts disagreed.In Roberts’ majority opinion, he essentially rewrote portions of the law to suit his own diagnosis, then reported that his examination of this now rewritten law was no reason for worry after all. If only we could get a second opinion!Fortunately, for Floridians, the question of “What now?” already has a partial answer, courtesy of Gov. Rick Scott. After analyzing the Roberts ruling, he affirmed thatFloridawon’t take part in two programs — one for which the court said state participation is optional, and one for which the ACA law itself offered an out.First,Floridawon’t take part in the massive expansion of Medicaid. ACA coercively threatened to reduce or cut off the federal share of funding for the current Medicaid programs in states that refused to go along with this costly expansion.The U.S. Supreme Court disagreed. By an impressive 7-2 margin — with even two of the most liberal justices concurring — the court said that this was a step too far and that it clearly violated the states’ rights. This vindicated an argument that the James Madison Institute made when it filed its amicus brief in this case.Although critics ofFlorida’s nonparticipation will argue that the state is forgoing the billions of dollars that the federal government will supply during the early years of the Medicaid expansion, steering clear of the costly expansion is a wise move in the long run, because the promise of future federal dollars is a shell game not worth playing. Ultimately those federal dollars would run out, andFloridataxpayers would be left on the hook.Indeed, the current Medicaid program is already devouring an inordinate share of the state budget, diminishing the funds available for other important priorities ranging from education to public safety, so a costly expansion of it is the last thingFloridaneeds.Second, Gov. Scott has declared thatFloridawon’t set up the kind of “health exchange” that ACA contemplates. In states that don’t set up such an exchange — essentially a “menu” of health-insurance plans — the feds will step in to do it.Why risk ceding this chore to the feds? A better question is this: Why should Florida go to the trouble and expense of doing this if there’s even a slight chance that ACA will soon be repealed, thereby letting states handle their own distinctive health-care needs without the one-size-fits-all mandates from Washington, D.C.?To some, repeal may seem like a long shot, but this deeply partisan bill passed along rigid ideological lines remains by large margins deeply unpopular with the American people. Simply put, they have a deep distrust that large government programs can be effective.Moreover, with little more than 100 days until the start of early voting, there are no guarantees concerning how this year’s presidential and congressional elections will turn out — and, in most states, there are still important party primaries to be decided. This may sound like an awfully short time for anything as significant as the future fate of Obamacare to be decided.Yet “100 days” also may sound like an agonizingly long time to wait until Americans can decide the fate of Obamacare, in the venue where these kinds of decisions are best made: not in the marble temple of the U.S. Supreme Court but in the voting booth.