MIAMI — As many states prepare to introduce a linchpin of the 2010 health care law — the insurance exchanges designed to make health care more affordable — a handful of others are taking the opposite tack: They are complicating enrollment efforts and limiting information about the new program.
Chief among them is Florida, where Gov. Rick Scott and the Republican-dominated Legislature have made it more difficult for Floridians to obtain the cheapest insurance rates under the exchange and to get help from specially trained outreach counselors.
Missouri and Ohio, two other states troubled by the Affordable Care Act, have also moved to undercut the law and its insurance exchanges, set to open on Oct. 1. In Georgia, the state insurance commissioner, Ralph T. Hudgens, has said he will do "everything in our power to be an obstructionist."
Alarmed by the resistance, the secretary of health and human services, Kathleen Sebelius, and the Obama administration are intensifying their efforts to win public support for the exchanges in Florida and elsewhere and are confronting their critics head on.
On Tuesday, Ms. Sebelius capped a three-city visit to Florida — home to the country's second largest uninsured population — with sharp words about the state's unwillingness to embrace the law. She will do the same in Missouri later this week.
"It's unfortunate that keeping information from people seems to be something of a pattern here in the state," Ms. Sebelius said at a news conference in Miami, referring to restrictions on outreach counselors.
The online exchanges are designed to offer a variety of insurance plans at subsidized prices and are meant to make health care more affordable to lower-income people who do not have insurance. Outreach counselors, known as navigators, provide information about the plans and help enroll applicants.
Ms. Sebelius also criticized Florida's rejection of $50 billion in federal money over 10 years to expand Medicaid, its concerns about privacy issues, which she said were unfounded, and its sudden unwillingness to grapple with insurance rates.
Even among states hostile to the law, Florida became an outlier this year when it passed a bill removing for two years the state insurance commissioner's ability to approve insurance rates for new health plans, she said. This leaves Floridians vulnerable to higher rates at a time when the new health plans will be introduced.
In other states, insurance commissioners used the law to obtain better deals for consumers.
"To have the Florida Legislature pass a bill that for two years — 2014 and 2015 — removes rate-review authority really puts Florida consumers at great risk," Ms. Sebelius said, adding, "No one else has done that."
Ms. Sebelius's criticism is unlikely to inspire cooperation in Florida or in the other states that vigorously oppose the law. Mr. Scott has been one of the law's fiercest opponents, despite his decision to accept the $50 billion for Medicaid expansion. But the Florida House blocked that effort this year while Mr. Scott sat mostly on the sidelines, failing to lobby for the expansion, lawmakers said. The state also chose not to run its own health care exchange, leaving it to the federal government.
Democrats said Mr. Scott and Republican lawmakers continued to throw up roadblocks.
Last week, Florida's deputy health secretary ordered county health facilities to bar navigators, or outreach counselors. The health department said it was following established policy: All outside groups are prohibited from using county health property to conduct nonstate business. Brochures, though, will be made available, according to a statement. No written requests for space have been made by navigators, a spokesman said.
County health offices are important in the campaign to reach potential applicants because they deal mostly with lower-income people who may not be insured.
And on Monday, in a letter to the top Republican and Democrat in Congress, Mr. Scott raised concerns about privacy, saying that navigators and others involved in the health care effort could use applicant information improperly. Attorneys general from 13 states have expressed similar worries about the release of financial and medical information — be it intentional or accidental.
Saying that Florida was "ground zero" in the Obama administration's campaign to enroll people, Mr. Scott asked House Speaker John A. Boehner and the Senate majority leader, Harry Reid, "to thoroughly review what privacy rules and safeguards are in place."
"Floridians should not have to exchange their privacy for insurance," Mr. Scott wrote.
Ms. Sebelius said on Tuesday that she appreciated the governor's concerns but that her office, which oversees Medicare, is used to dealing with privacy issues.
"I can guarantee you we take that very, very seriously, which is why nobody will be collecting personal health information at all at any point along the way," she said. "Verifying, yes; storing it, no."
Florida is not the only state complicating the Obama administration's efforts to roll out the new exchanges.
A Missouri law adopted this year requires the licensing of navigators and also restricts their activities. Without that license, the Missouri law says, navigators cannot "provide advice concerning the benefits, terms and features of a particular health plan" or "advise consumers about which health plan to choose."
Ohio has adopted a similar law, stating that navigators can distribute some information but cannot recommend a plan or offer advice about benefits in a particular plan.
In Georgia, the insurance commissioner, Mr. Hudgens, said his "job is to protect consumers." To that end, Georgia mandates that health insurance counselors be licensed to become navigators, a process that requires criminal background checks and fingerprinting of applicants.
For Democrats, the new state laws and rules are just another way to throw up obstacles to try to defeat the Affordable Care Act.
"They couldn't beat Obamacare in Congress, where they've tried 41 times to repeal it, they couldn't beat it in the Supreme Court, so they are trying death by a thousand cuts," said Representative Debbie Wasserman Schultz, a Florida Democrat and chairwoman of the Democratic National Committee.
Lizette Alvarez reported from Miami, and Robert Pear from Washington.
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