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Utah and Florida are the lone undecideds. Because Utah already operates its own version of an exchange, Republican Gov. Gary Herbert this week asked Mr. Obama to approve the program, which he said gives 7,600 people and 318 small businesses a choice of 140 health insurance plans.

But Utah’s plan isn’t designed to offer health insurance to individuals, as required in the federal law, so it’s uncertain if the governor’s plea will be successful.

In Florida, GOP Gov. Rick Scott, one of the most strident critics of the president’s health care overhaul, has softened his tone since the November elections, saying he now is willing to negotiate with the federal government.

But the Republican-controlled Florida Senate this week launched a Web page saying the state can’t make a decision on an exchange until the 2013 legislative session and therefore likely wouldn’t have time to create a state-run exchange by the mandated January 2014 start even if it wanted to.