Ala. governor rejects state exchange, Medicaid expansion

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The Affordable Care Act envisions each state setting up its own exchange, but authorizes a federally run fallback in states that do not act. So although Republicans criticize the ACA as a government overreach, declining to run an exchange invites greater federal control over a key system that could have been in the state's hands.

But the national implications were clearly on Bentley's mind.

“I am not going to set up a state-based exchange that will create a tax burden of up to $50 million on the people of Alabama. As governor, I cannot support adding such a tax burden onto our citizens,” Bentley said in a statement. “The Affordable Care Act is neither affordable nor does it actually improve healthcare. Congress and the president have said they want to work together to solve the fiscal crisis facing this country, and I suggest they start with this healthcare bill.”

The Obama administration has asked states to declare by Friday whether they want to set up their own exchanges. States have until February to decide whether they'll share the task with the federal government or cede the policy entirely to Washington.