With President Obama's re-election effectively ending any threat of a quick repeal of his health care law, more states are moving forward on a key component of the Affordable Care Act ahead of a mid-December deadline.
At least 23 states are on track to set up statewide health-insurance-buying exchanges, either by themselves or in partnership with the federal government — a number that has ticked upward since the Nov. 6 elections.
About 10 or 11 states are undecided, with the rest saying they want no part of the program.
Republican presidential nominee Mitt Romney had vowed to repeal "Obamacare" if he won. But since his loss, some GOP governors who oppose the law have grudgingly said they'll consider setting up exchanges in their states.
Florida Republican Gov. Rick Scott, one of the most vocal critics of the federal health care overhaul, has softened his tone since the election, saying he now is willing to negotiate with the federal government. While still undecided on how to approach the health care law, he says it's time for Republicans to offer solutions after losing the bid for the White House.
"The election is over and President Obama won," said Mr. Scott, who once ran one of the nation's largest hospital chains. "I'm responsible for the families of Florida. If I can get to yes, I want to get to yes."
States have until Dec. 14 to notify federal authorities if they plan to set up their own insurance exchanges — a marketplace where individuals and small businesses can shop for the most affordable coverage and where many will get help from the government to pay their premiums.
States also can choose to set up an exchange under a state-federal partnership, with a decision on that option due Feb. 15. If any state is undecided after that, the federal government will run that state's exchange.
The deadline for both decisions initially was earlier this month, but the federal government offered the extension after some governors asked for more time.
Seventeen states and the District of Columbia say they'll create their own exchanges, while six intend to set one up in partnership with the federal government, says the Kaiser Family Foundation, a nonpartisan group that tracks and analyzes health care issues. Those numbers collectively have increased by about a half-dozen since Election Day.
Sixteen mostly Republican-controlled states say they will let the federal government run their state's exchange, Kaiser says.
Some states say they're holding off on a decision until they get more information on rules, procedures and costs — especially on cost-comparisons among the three options.
New Jersey Gov. Chris Christie has vowed his state "is going to comply with the Affordable Care Act," though he said he is waiting on answers to some 30 questions presented to Health and Human Services Secretary Kathleen Sebelius before deciding what to do.
"If they're willing to answer the questions, and I can evaluate how much it's going to cost, then I might be inclined to do a state-run exchange," the Republican governor said last week. "If they're unwilling to answer the questions for me, then they're going to run it and let them bite it."
He added if he decides to let the federal government run New Jersey's exchange, "that's complying with the Affordable Care Act."
Other states have held back on their decision due to new governors taking office or an upcoming change in party control of the legislature.
In Indiana, outgoing Republican Gov. Mitch Daniels has deferred a decision on exchanges to the new governor. GOP Gov.-elect Mike Pence, since his election earlier this month, has said he doesn't want a state-based exchange because he can't reasonably justify the estimated $50 million annual cost to Indiana.
"Despite this investment, there is no evidence that such an exchange would benefit Hoosiers, give us significantly more control over our health care choices or lower the cost of insurance premiums," Mr. Pence said in a recent letter to Mr. Daniels.
Mr. Pence, who is serving out his sixth term in the U.S. House, which will expire in early January, added he is opposed to a state-federal partnership "absent new information."
New Hampshire initially said it would let the federal government run its exchange. But with Democrats regaining control of the state House in the November elections, lawmakers there may revisit the decision.
New Hampshire Gov.-elect Maggie Hassan, a Democrat, wants to discuss the state's options with lawmakers, business owners and others before deciding, a spokesman said.
While the federal government reserves the right to extend the deadlines again, time is running out. Open enrollment for the exchanges is scheduled to begin in October, with coverage to start in January 2014.
• This story is based in part on wire service reports.
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