story first appeared on nytimes.com
The days since President Obama won re-election have been marked by tension and angst in Republican-led states like Iowa, where Gov. Terry Branstad has waited until the last minute to decide whether to create a crucial tool for people to get medical coverage under Mr. Obama’s health care law.
State Senator Jack Hatch, a Democrat who vented his frustration at a news conference here this week, said there had been a total blackout of information, and they they are behind schedule and at a disadvantage.
States are supposed to tell the Obama administration by Friday whether they want to create their own health insurance exchange — a deadline that many had bet might never come to pass, choosing to sit on their hands for months in the hope that Mitt Romney would win the presidency and the health care law would be repealed.
On Wednesday, they dug in their heels a little more. Leaders of the Republican Governors Association, gathering in Las Vegas for their annual meeting, wrote a letter to Mr. Obama requesting more time, more guidance and a meeting where the president and governors could talk.
Insurance exchanges — basically online markets where the uninsured can shop for private health insurance, often with federal subsidies to help pay — are considered critical to making the health care law work. So far, 17 states, most led by Democrats, and the District of Columbia have indicated they will create their own state-run exchanges.
The other options are setting up an exchange in partnership with the federal government, or simply letting the federal government do it.
Every state is supposed to have an exchange by Jan. 1, 2014, when the health care law will require most Americans to have insurance. The exchanges are supposed to be ready to start enrolling people in October 2013.
Despite the unhappiness, there are indications that some Republican governors may be softening their opposition to the law. Gov. Rick Scott of Florida, a Republican who had been one of its toughest critics, signaled this week that he would be open to compromising.
And Governor McDonnell of Virginia — like Florida, a state Mr. Obama carried — noted that while his state had been the first to file suit seeking to block the law, it would comply with it.
But he said that the complexity of the law, and the lack of details from Washington, meant that “my best experts in Virginia, my doctors and others that are advising me on what to do, say they still can’t make a prudent call between a state or federal exchange because we don’t have all the answers.”
Others are facing intense, sometimes conflicting pressures from state legislators and interest groups. In Wisconsin, health care providers and business groups are lobbying Gov. Scott Walker to create a state exchange, while Tea Party groups are warning him not to.
At the Republican governors meeting in Las Vegas, Mr. Walker said in an interview that he would prefer a state-based program, but that he doubted that the federal government would allow him to shape it as he saw fit.
He said that he would not disclose his decision until Friday, but added, “Why do I want to take on the potential risk to my taxpayers if I don’t really have any true authority about what’s going to happen?”
Republicans who support state-run exchanges say they are embracing a fundamental conservative belief: that states should make their own decisions rather than cede control to the federal government. But others argue that deferring to the federal government is a shrewder move; that way, they say, it will not be their fault if anything goes wrong.