You can lead a Republican to health reform, but you can't make him implement it. Scott Walker of Wisconsin and Rick Perry of Texas are the latest Republican governors to say that they, in opposition to Obamacare, will not be setting up a health exchange network in their respective states. Health exchange networks are a key component to Obamacare, President Obama’s signature health reform law. These exchange networks create a marketplace for insurance customers to choose a provider. They are meant to be run by each individual state, and this, in turn, requires the sign off of each state’s governor. Walker stated his opposition in a letter to Health and Human Services Secretary Kathleen Sebelius:
No matter which option is chosen, Wisconsin taxpayers will not have meaningful control over the health care policies and services sold to Wisconsin residents. If the state option is chosen, however, Wisconsinites face risk from a federal mandate lacking long-term guaranteed funding.
The Republican governors who refuse to comply with this central provision of Obamacare can now comfortably field a baseball team: 16 states have issued letters stating that they have no intention to set up a health exchange. This does not mean that residents of these states won’t have a health exchange, it simply means that the federal government will be operating it, as opposed to the state. This fact provides some political cover for the governors turning down the exchange. They get the program while publicly opposing it. They also score points among Republican insiders by making life that much more difficult for the Obama administration.
Avalere health provides this very helpful map to track the health-exchange decisions of each state.