Several Republican governors have announced they will not implement a state-run health care exchange, ceding control to the federal government.
The health care exchanges, a key component of Obamacare, are meant to help individuals and small businesses by providing them with an online market to compare and purchase private health insurance plans. The exchanges are required to be fully operational by January 1, 2014.
States can opt to build their own health care exchange, enter into a state-federal partnership, or allow the federal government to establish the exchange.
Republican governors in Alaska, Alabama, Ohio, South Dakota, Maine, Nebraska, Missouri, Kansas, Louisiana, Texas, Georgia, Wisconsin and South Carolina have all said they will not run their own health care exchanges, turning over control to the Obama administration.
The GOP governors said that state-run health care exchanges lacked flexibility and would be too costly for the state to implement. Many of the governors argued there were so many federal regulations on state-run health care exchanges that it would practically be a federal program anyway.
"Regardless of who runs an exchange, the end product is the same," Ohio Gov. John Kasich said Friday in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius.
Kasich was echoed by Wisconsin Gov. Scott Walker, who on Friday told Sebelius in a letter, "No matter which option is chosen, Wisconsin taxpayers will not have meaningful control over the health care policies and services sold to Wisconsin residents."
The states were required to decide by Friday whether they would run their own insurance exchanges, but the Obama administration extended that deadline until December 14.
Seventeen states and the District of Columbia have decided to implement a state-run exchange, while Arkansas, Illinois, Delaware, North Carolina and Michigan have opted for a state-federal partnership.