The Patient Protection and Affordable Care Act has been a polarizing issue for many—and that's apparent when you look at how states are reacting to health care reform.
Despite the Supreme Court ruling upholding the law last month, it isn't all good news for the Obama administration. Health reform is lagging in several states. Half now face a federally run health care exchange, the default for states that haven't made progress or declined involvement in setting up a state run marketplace for health insurance coverage.
Officials at the National Association of Insurance Commissioners even warn it's too late to start a state-based exchange if work hasn't already been underway for a while.
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That's in large part due to the fact that many of those states are just not that into reform. These states—largely led by Republicans—aren't jumping the gun on complying.
See also "Five states embracing reform"
Though there's been a number of states voicing concerns, here are five examples of states who are not rushing to implement the law>>
Texas
Texas is among a chorus of states rejecting the two key proposals of the PPACA. Gov. Rick Perry—whose GOP presidential bid fell short earlier this year—said his state won't establish an online marketplace for patients to shop for insurance or expand Medicaid.
In a letter to Health and Human Services Secretary Kathleen Sebelius released this week, Perry rejected both proposals.
"If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under Obamacare," Perry stated. "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.
"I stand proudly with the growing chorus of governors who reject the Obamacare power grab. Neither a 'state' exchange nor the expansion of Medicaid under this program would result in better 'patient protection' or in more 'affordable care.' They would only make Texas a mere appendage of the federal government when it comes to health care," Perry continued.
According to a Commonwealth Fund report, individual Texas health insurance premiums increased by almost 50 percent in the past eight years while the increase in family and group Texas health insurance plan premiums was larger still. The number of people uninsured in Texas is the largest in the nation, at 25 percent.
New Jersey
Republican Gov. Chris Christie, pictured, says he won't rush into setting up a New Jersey health insurance exchange just because the Supreme Court upheld the PPACA.
He says the state should wait until at least November's election before taking steps to comply with the law.
After the Supreme Court announcement June 28, Christie made a statement reiterating his views against Obama's law.
"I've been clear from the very beginning that I do not believe a one-size-fits-all health care program works for the entire country and that each governor should have the ability to make decisions about what works best for their state. Today's Supreme Court decision is disappointing and I still believe this is the wrong approach for the people of New Jersey who should be able to make their own judgments about health care. Most importantly, the Supreme Court is confirming what we knew all along about this law—it is a tax on middle class Americans."
Wisconsin
In regards to health reform, Wisconsin Gov. Scott Walker has vowed not to do anything until after the November election.
Walker's been an outspoken critic of the law, and originally said he wouldn't do anything with the law until after the Supreme Court ruled. But now he says he's waiting until November.
Based on 2010 U.S. Census Bureau data, 90.6 percent people in Wisconsin had insurance coverage. That tied with Maine for the third-highest rate of any state, after Hawaii at 92.3 percent and Massachusetts at 94.4 percent.
Florida
Florida Gov. Rick Scott has said that his state will continue to resist implementing both the expansion of Medicaid and the state exchange.
He's argued against setting up exchanges, saying that they won't make health coverage cheaper and may not give people coverage they want.
Scott's indicated he hopes the November election will undo the PPACA.
Scott, a former health care corporation CEO, doesn't have the best approval rates.
Florida is right behind Texas with the nation's highest rate of uninsured residents, at 21 percent.
Virginia
Gov. Bob McDonnell says before Virginia policymakers make any moves, they need more answers from the Obama administration about Medicaid.
He also says it's too early to determine whether to create a state-based health benefits exchange or let the feds do it.
He said his health policy advisers, led by Health and Human Resources Secretary Bill Hazel, must learn more before Virginia retools its Medicaid program, already among the leanest in the nation.
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