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“While no one can predict what the Supreme Court will ultimately decide, it is imperative that the state prepare for any decision,” he said. “The steps we have taken to date, and the planning process we are putting in place, help ensure the state is able and ready to follow the law, if upheld, and also guarantees we don’t have the federal government running our insurance market.”

Cheryl Smith, a health exchanges consultant with the conservative firm Leavitt Partners, said she expects to see that response from other states in the aftermath of a decision upholding the law.

“I don’t know that Republican states are actually holding back so much as they are keeping all their options open,” Ms. Smith said. “I think in addition to a mad scramble, you will also see a redoubling of efforts to keep the feds out.”

Obama administration officials have emphasized flexibility in issuing rules for the exchanges, allowing states to choose how many plans to allow and how much assistance to accept from the federal government. But Ms. Smith said she expects that between five and 10 states won’t meet the conditions for approval by 2014.

Christie Herrera, director of the health task force for the American Legislative Exchange Council, said that for states holding back, she thinks it comes down to a matter of control. The administration is implementing other parts of Mr. Obama’s plan without any input from the states, she said.

“It’s basically the only tenet of Obamacare they can control,” she said. “They can’t really control the individual mandate, they don’t have control over the Medicaid expansion, but this they can refuse.”