TALLAHASSEE-Florida’s Republican-controlled state government is gearing up to fight federal health care reform even before the law passes.

Attorney General Bill McCollum, who is running for governor, signaled he would challenge the legality of any federal legislation that forces individuals to buy coverage. On Monday, a top state senator told a crowd that state legislators would resist making other changes required to implement the reforms.

“We are not trying to figure out how to lay down with this,” said State Sen. Don Gaetz, R-Destin and chairman of the Senate Health Regulation Committee. “I think we are going to look for ways to roll back provisions in this bill and try to get more state choice and more flexibility and more local business control of health care options.”

Another speaker, Deputy Insurance Commissioner Mary Beth Senkewicz, said the state would have to significantly overhaul its insurance laws to be in compliance with the federal legislation.

Changes that would be required, she said, include stiffening requirements on how much of the premium dollar must be spent on patient care (“the medical-loss ratio”) and requiring broad physician networks in preferred provider organizations.

It isn’t clear what would happen if the state refused to make the changes necessary to comply with the federal law. In other federal legislation, such as federal highway speed limits, states have been persuaded to go along by threatening to withhold federal funds.

Gaetz predicted that in 2010, candidates opposed to the federal reform would win election, setting off a protracted fight.

After the bill is signed into law, “the fight just moves to a different venue,” Gaetz said. “And by the way, I welcome the fight.”

Bills that passed the U.S. House and Senate take varying approaches but both would extend health care coverage to at least 31 million uninsured Americans. They would require that all individuals be covered – to avoid a situation in which only the sick buy policies –  expanding Medicaid and offering premium to help those who can’t afford to buy insurance.

Republicans have almost unanimously opposed health care reform, the top domestic priority of President Barack Obama. Last year Republican state legislators sent letters to Florida’s U.S. senators saying they were opposed to any bill that would substantially expand the eligibility standards for Medicaid. Then in December, McCollum said he would investigate the legality of the mandate.

Gaetz’s comments to the 2010 Florida Health Care Summit, The Florida Response in Tallahassee were met with applause. The summit was sponsored by the National Association of Insurance and Financial Advisors – Florida and the Florida Association of Health Underwriters.

Insurance Commissioner Kevin McCarty, who opened the conference, expressed concerns that the federal reform legislation doesn’t address health care costs. McCarty said the pending legislation “does nothing to address reining in health care costs in America. While it’s been largely touted as health care reform, it is a health insurance bill, make no mistake about it.”

McCarty highlighted a number of what he said were “concerns” with the federal legislation, most notably the requirement in the House bill that some insurance reforms be overseen at the federal level by a national commissioner.

A letter to Congress that McCarty co-signed as vice president of the National Association of Insurance Commissioners supports most of the goals of the federal legislation, including expansion of coverage to the uninsured, the creation of a health-insurance exchange and protections against loss of coverage for those already insured. The letter, in fact, asks Congress to strengthen some of the features that have drawn Republican opposition, including the “individual mandate” that requires everyone to buy insurance.

The main objection the letter expressed was to creation of a federal agency that would usurp some of the authority of state insurance commissioners.

“State insurance regulators have the requisite expertise to deal with the regulation of health insurance. Health delivery system begins at home and not in Washington, DC,” said McCarty.

–Christine Jordan Sexton is co-founder of TallahasseeReporters.com.