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Even then, eligible states would have to show that they would be just as successful in delivering health care services.

Dan Mendelson, CEO of Avalere Health, a consulting firm for health care companies, and former associate director for health at the Office of Management and Budget (OMB), said that Mr. Romney will still have other tools at his disposal to slow the implementation of the president’s health care plan by cutting off funding to the state health exchanges, and delaying various aspects of the law.

Romney would have very broad flexibility to slow down the implementation of reform and in some places to halt it, but that state waiver authority is restricted under the law,” he said.