Analysis: 20 states will run their health-law exchanges

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According to Avalere, 13 states are likely to use the partnership model, while more than a third will default to a federally run exchange.

In their choices, Republican governors face a balancing act — not going too far to embrace the law, which remains divisive with the public and anathema to conservatives, but also not skipping a chance to wrest authority from the federal government.

In Missouri, voters passed a ballot measure Tuesday that prohibits Gov. Jay Nixon (D) from creating an insurance exchange unless the move is authorized by the state legislature or by a ballot initiative. The measure's passage all but ensures that the federal government will run Missouri's exchange.

Avalere added Wednesday that six states have indicated they will not pursue the law's offer to expand Medicaid.