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Obama's signature on Affordable Care Act
The Department of Health and Human Services gave states an extra month to make the final decision on whether or not they would set up health exchanges themselves under the provisions of the Affordable Care Act, or have their states participate in the federal exchange. The initial date was too soon for many governors, who were holding out hope for a Romney win and repeal of Obamacare, hence this extension. The last of the decisions are trickling in.

Gov. Butch Otter in Idaho has chosen to set up the exchange, following the recommendation of a bipartisan panel he created to advise him on that. He was as wing-nutty conservative as he could be in announcing his decision:

"There will be a health insurance exchange in Idaho," Otter said in a statement. "Our options have come down to this: Do nothing and be at the federal government's mercy in how that exchange is designed and run, or take a seat at the table and play the cards we've been dealt. I cannot willingly surrender a role for Idaho."
but he's doing it.

On the other hand, Pennsylvania's Republican Gov. Tom Corbett is not, missing the boat on the great wing-nutty opportunity to talk about avoiding the "federal government's boot on our throats" rhetoric so deftly deployed by Otter.

"Health care reform is too important to be achieved through haphazard planning," Corbett said, according to the Associated Press. "Pennsylvania taxpayers and businesses deserve more. They deserve informed decision making and a strong plan that responsibly uses taxpayer dollars."
Whatever, governor. Likewise, Tennessee's Gov. Bill Haslam will leave it up to the feds, using basically the same rhetoric as Corbett about uncertainty.

Another hold-out is Utah, which is in a slightly different circumstance. The state already has an insurance exchange, and is trying to get it grandfathered in to the law. It's not likely to happen without significant changes in the existing exchange, says Jennifer Tolbert, director of state health reform at the nonpartisan Kaiser Family Foundation.

First, Utah’s plan is not designed to offer health insurance to individuals as required in the federal law. Secondly, Utah’s is not structured to distribute federal tax credits aimed at low income people who are uninsured. Utah plans to open up the plan to individuals in the future.
Finally, in related news, Nevada's Republican Gov. Brian Sandoval announced his state would take the Medicaid expansion money offered to states under Obamacare. Nevada agreed to set up its exchange two years ago, so that's no longer an issue. Since the Supreme Court ruled that states could opt out of the expansion, nine states have declined the expansion, so far. There's potentially room for them to revise that decision when they realize the scope of what they're missing out on. There is no firm deadline for a decision on Medicaid expansion.

Originally posted to Joan McCarter on Wed Dec 12, 2012 at 03:48 PM PST.

Also republished by Daily Kos.

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