States have until next year — Feb. 15 — to decide on an exchange operated jointly between the state and HHS. The "partnership" model could be attractive to governors who had held off serious implementation work until after the presidential election but do not want to completely cede control to the federal government.
Conservatives are urging states not to take any action on exchanges, saying their resistance is the best way to undermine the law now that the Supreme Court upheld it and President Obama's reelection ensured it will not be repealed.
But even some conservative governors have been quietly studying how an exchange would work, preferring to set their own rules rather than defer to HHS.
The healthcare law requires HHS to certify by Jan. 1, 2013 whether each state will be able to have its own exchange up and running by Jan. 1, 2014.
Exchanges will function as one-stop shops where small businesses and people who do not get coverage through their employer can shop for insurance. HHS would prefer to see states operate their own exchanges, because insurance is regulated primarily at the state level, and it has previously extended funding deadlines to try to coax reluctant governors to pick up at least part of the task.
— This post was updated at 5:34 p.m.