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Some states are going alone in their pursuit of a winning formula. For instance, Idaho appears to be the only state opting to run its exchange in-house while rejecting an infusion of federal dollars to expand Medicaid — at least for now.

Although Idaho Gov. C.L. “Butch” Otter is no fan of the president’s law, he said state officials must “play the cards we’ve been dealt” and take control of its exchange. He is employing a wait-and-see approach to expanding Medicaid because he believes the current system is broken, according to his spokesman, Jon Hanian.

“The governor is very aware there are uncertainties in this, but we knew that from the get-go,” Mr. Hanian said.