Florida officials who challenged the health care law were overconfident of victory and have been slow in setting up insurance exchanges required under the law.
As one of his first official acts, Gov. Rick Scott turned down more than a million dollars to begin implementing the Affordable Care Act.
"We're not going to spend a lot of time and money to get ready to implement that until we know what happens," Scott said in February 2011.
The money in 2011 would have gone to establishing online heath exchanges for consumers to compare rates. At the time, Scott promised, "The state won't be caught flat-footed."
On Friday, health care advocates were chastising the governor for not moving more quickly.
Earlier this year, state lawmakers talked about setting up a mechanism for accepting federal money if the health care did become law. The governor threatened a veto, so it didn't happen.
The money would help provide more care for up to a half-million children. Dr. Louis St. Petery, a cardiac pediatrician, said the current system treats them unfairly.
"You take grandma to the doctor for a sore throat and they pay 56 percent more for the doctor than the pediatrician who sees the grandchild for the same sore throat," Petery said.
The dilemma for Scott is that the program is only fully funded for the first two years. After that, the state pays $1 of every $10. On Thursday, the governor was uncertain about what the state would do next.
"I've got to read through the decision to make sure we understand it," he said.
Scott is also hanging his hat on his support for Mitt Romney. Romney has already promised to repeal the Affordable Care Act.
The state can still take advantage of $450 million in federal money to provide better health care for children if the Legislature acts before January.