Obamacare directs states to establish exchanges through which uninsured people can purchase coverage. If the states don’t do it, the law says the federal government will step in and set up an exchange itself. The Obama administration has been trying to push the governors to say whether they will set up exchanges in their states. So far, most of the Republican governors seem inclined to say no.
They have several reasons. One, they believe the exchanges will cost their states a lot of money. Two, they believe the federal government will exercise ultimate control, meaning there will be little benefit for a state to do the heavy lifting to get the exchanges started. And three, some suspect the exchanges will be a disorganized and troubled enterprise, and when the implementation of Obamacare comes under criticism, the blame will lie with the administration, and not the states.
Some conservatives are urging the governors not only to stay out of the exchanges but also to reject Obamacare’s planned expansion of Medicaid. That could be a crippling blow to the health care law. “If enough states do so, Congress will have no choice but to reopen Obamacare,” Cato Institute health care scholar Michael Cannon wrote in National Review Online recently. “With a GOP-controlled House, opponents will be in a much stronger position than they were when this harmful law was enacted.”