Although he supported health insurance exchanges during his 2010 campaign, Gov. Robert Bentley, R-Ala., later opposed a state-run exchange, stating, "The Affordable Care Act is neither affordable nor does it actually improve health care."
Gov. Sean Parnell, R-Alaska, opposed a state-based exchange, saying, "Alaskans will not see our state treasury bear the additional costs of maintaining and operating the underfunded federal mandate that is Obamacare."
Though Gov. Jan Brewer, R-Ariz., was against the Affordable Care Act, she initially established a state Office of Health Insurance Exchange. She later announced that the state would default to a federally run exchange.
Though consumers access Arkansas' exchange through the federal website, the state's insurance marketplace represents a partnership with the feds. The state is overseeing the health plans and handling consumer assistance.
California was the first state to authorize its own exchange after passage of the Affordable Care Act. Some major players in the health insurance industry, including Aetna and UnitedHealthcare, have decided not to participate.
Colorado is the rare state to have bipartisan support for a state-run exchange. Republicans felt that was preferable to federal control; a key Republican lawmaker called Obamacare a disaster.
Connecticut was one of the earliest states to begin establishing its own insurance marketplace. Hartford, Conn.-based Aetna has chosen to sit out the exchange because the company said price constraints would make participation unprofitable.
Delaware's exchange represents a partnership with the federal government. The state is interested in entering into a regional exchange with nearby states to reduce administrative costs.
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Despite its small size, D.C. decided to open its own health exchange. In an issue that has been contentious, the City Council mandated that small-business employers use the exchange for their employees, starting in 2015.
Gov. Rick Scott, R-Fla., and other Florida officials not only refused to establish a health insurance exchange, but they also gave up a $1 million federal grant related to health care reform.
In a letter to Health Secretary Kathleen Sebelius, Gov. Nathan Deal, R-Ga., rejected a state-based exchange and criticized what he called the "one-size-fits-all approach" and "high financial burden" of Obamacare.
Since 1975, Hawaiian law has mandated that employers provide health insurance to workers. Hawaii was one of the first states to move to establish a state health care exchange under the Affordable Care Act.
Idaho officials decided to establish a state-run exchange; the governor said Gem State residents like to do things for themselves. When the site wasn't ready in time, Idaho used HealthCare.gov during the Affordable Care Act's first open enrollment season.
Despite Democratic control of state government, Illinois has been slow to establish a state-run exchange. For now, the state is partnering with the federal government and hopes to have a state-run exchange by 2015.
Gov. Mike Pence, R-Ind., rejected a state-run health exchange, citing what he called "the certainty of higher taxes and higher premiums for Hoosiers."
Iowa planned to partner with the federal government through 2014, then transition to a state-run health exchange. Iowa's largest health insurer, Wellmark Blue Cross/Blue Shield, chose to sit out the first year of the exchange.
Gov. Sam Brownback, R-Kan., rejected a state-run exchange and any partnership arrangement with the feds, saying, "We will not benefit from it and implementing it could cost Kansas taxpayers millions of dollars."
In July 2012, Gov. Steve Beshear, D-Ky., signed an executive order to create a state-run exchange. A tea party activist filed a lawsuit questioning the legality of the state's exchange.
Gov. Bobby Jindal, R-La., an outspoken critic of Obamacare, rejected the idea of a state-run health insurance exchange. The state returned $1 million in federal funds for exchange planning.
Gov. Paul LePage, R-Maine, rejected a state-based exchange in a letter to Health Secretary Kathleen Sebelius. He wrote that the Affordable Care Act has "severe legal problems."
Maryland began establishing a state-run exchange before the U.S. Supreme Court's June 2012 decision upholding the Affordable Care Act. Insurance giant Aetna dropped out of the exchange after its proposed rates were slashed by regulators.
The health care exchanges of the Affordable Care Act are modeled on the system in place in Massachusetts since 2006. The state has had to bring its Health Connector in line with Obamacare.
Gov. Rick Snyder, R-Mich., supports a state-run health exchange so the state can make its own decisions, but the legislature split and failed to approve either a state exchange or a partnership with the federal government.
Minnesota's legislature switched from Republican to Democratic control in 2012 and then passed legislation to create a state-run health insurance exchange, as supported by Gov. Mark Dayton, D-Minn.
Gov. Phil Bryant and state Insurance Commissioner Mike Chaney clashed over health insurance reform. Chaney attempted to establish a state-run insurance exchange without Bryant's support, but that idea was rejected by the federal government.
Missouri has allowed the federal government to take full control of its health exchange. That's after voters overwhelmingly approved a law prohibiting Gov. Jay Nixon, D-Mo., from establishing a state insurance exchange.
Montana's state legislature passed a bill prohibiting the state from establishing a health insurance exchange. Although Gov. Brian Schweitzer, D-Mont., vetoed the bill, the state has deferred to a federally run exchange.
Gov. Dave Heineman, R-Neb., announced that Nebraska would not establish a state-run insurance exchange. He said a state exchange would be too expensive and would not have enough autonomy from the federal government.
Nevada's state-run health insurance exchange was one of the earliest organized and has inspired other states. Officials planned to sell advertising space on the Nevada Health Link website to bring in extra money.
Then-Gov. John Lynch, D-N.H., signed a bill in 2012 prohibiting the state from operating its own exchange. Early in 2013, newly elected Gov. Maggie Hassan, D-N.H., announced plans for a state-federal partnership exchange.
Gov. Chris Christie, R-N.J., vetoed a bill passed by the state Legislature to establish a state-run health exchange, leaving the Garden State to default to federal control.
New Mexico's governor opposed Obamacare and initially vetoed a state-run health exchange before signing legislation to create one. The state relied on HealthCare.gov during the Affordable Care Act's first open enrollment period because the New Mexico site wasn't ready.
Gov. Andrew Cuomo, D-N.Y., issued an executive order in 2012 to establish a state-run exchange after the legislature failed to act. An advertising agency named the exchange, "New York State of Health."
Gov. Pat McCrory, R-N.C., announced that the state would default to a federally operated exchange. He said it was impossible to determine "the potential long-term cost to the North Carolina taxpayer" for the state to establish its own exchange.
Although North Dakota's legislature voted to explore the possibility of a state-run insurance exchange, Gov. Jack Dalrymple, R-N.D., later announced that the state would not establish one and would instead default to the federally run exchange.
The state declined to set up its own exchange. Lt. Gov. Mary Taylor, R-Ohio, said the federally run exchange will have consumers paying 41 percent more in health insurance premiums, but federal officials scoffed at the state's numbers.
The state declined to establish its own insurance exchange. Oklahoma also sued the federal government, claiming that aspects of the Affordable Care Act don't apply in states that don't create their own exchanges.
The Cover Oregon state-run exchange didn't work during the Affordable Care Act's initial open enrollment period, forcing the state to use paper forms to sign up residents for health plans. As a result, Oregon decided to switch to using HealthCare.gov.
Gov. Tom Corbett, R-Pa., rejected a state-run health insurance exchange and any partnership with the federal government. As he put it: "Health care reform is too important to be achieved through haphazard planning."
Gov. Lincoln Chafee, I-R.I., established a state exchange by executive order in 2011. The exchange's director expects up to 100,000 Rhode Islanders will use it during its first 18 months.
Gov. Nikki Haley, R-S.C., opposed a state-run health insurance exchange and informed federal officials they would be running things. Later, state lawmakers considered a bill making it a crime to implement Obamacare.
Gov. Dennis Daugaard, R-S.D., a consistent opponent of the Affordable Care Act, said the estimated cost of establishing a state-run health care exchange was too high, so the state would opt for a federally operated marketplace.
Gov. Bill Haslam, R-Tenn., announced in December 2012 that the state would defer to a federal exchange out of concern that the federal government would impose too many regulations on a state-controlled exchange.
Gov. Rick Perry, R-Texas, firmly rejected a state-based exchange, saying, "I will not be party to socializing health care and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government."
Utah already had a state health insurance exchange in place, but it offers insurance only to small businesses and not individual consumers. The federal exchange is covering the individual market.
Vermont's state-run exchange is seen as just a first step toward universal health care. In 2017, the state plans to switch to a single-payer system providing health insurance for every Vermonter.
Gov. Bob McDonnell, R-Va., signed a law indicating the state would establish its own exchange, but Virginia eventually decided to default to a federally run exchange. The state is overseeing the health plans.
Gov. Christine Gregoire, D-Wash., moved fairly quickly to establish a state-based health insurance exchange. The state planned to spend $26 million on advertising to spread the word about its exchange.
Gov. Earl Ray Tomblin, D-W.Va., had signed a law to set up a state-run exchange. But he later put the state on a path toward partnering with the federal government because of concerns about costs.
Gov. Scott Walker, R-Wis., initially supported the idea of a state-run health insurance exchange but later changed his mind because he said the state would have no real control and too much financial risk.
Gov. Matt Mead, R-Wyo., announced that the state would default to a federally operated exchange for 2014, but he has left open the option of a future state-run exchange.