“The Obama administration faces major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems.
Sixteen states — most of them governed by Republicans — have said they will not set up their own systems, forcing the federal government to come up with one instead.
Another five states said they want a federal-state partnership, while four others are considering partnerships.
It’s a situation no one anticipated when the Affordable Care Act was written. The law assumed states would create and operate their own exchanges, and set aside billions in grants for that purpose.”