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Obamacare won't be repealed. States now must act.

As House Speaker John Boehner said this week, the presidential election confirms that the Affordable Care Act 'is the law of the land.' But the fight over 'Obamacare' is not over as states decide whether to craft their own insurance exchange program or leave it to Washington.

By Staff writer / November 10, 2012

Supporters of the Affordable Care Act rally in front of the US Supreme Court in Washington in March as the court heard arguments on the health care law signed by President Barack Obama.

Charles Dharapak/AP

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Mitt Romney declared many times during his campaign that he’d “repeal Obamacare on day one” of his presidency. But as House Speaker John Boehner said this week, “the election changes that.”

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The 2010 Patient Protection and Affordable Care Act – “Obamacare,” as everyone now calls it – is designed to extend health coverage to more than 30 million uninsured Americans beginning in January 2014.

Under the law, states must decide whether to expand their Medicaid coverage for low-income Americans (to be paid for by the federal government) and also whether to form health care insurance exchanges – an online marketplace where individuals and small businesses can shop for health insurance, presumably in a more competitive environment.

Sixteen states and the District of Columbia are on track to set up their own exchanges, while nine have decided they will not, according to an Associated Press tally. The federal government could end up running the new health care insurance markets in half or more of the states.

Americans for Prosperity (AFP), the conservative advocacy group linked to the Koch brothers, is pushing governors to resist the law’s Medicaid expansion and state-based insurance exchanges, reports The Hill magazine.

“States can and do have the power to reject federal attempts to compel their action. Governors should use that power to tell the federal government no,” AFP state policy manager Nicole Kaeding said in a statement Friday. “By creating an exchange, states will serve as de-facto administrators of the federal government implementing its rules, regulations and mandates.”

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Kansas Gov. Sam Brownback (R) is typical of those refusing to cooperate with Obamacare.

“Kansans feel Obamacare is an overreach by Washington and have rejected the state’s participation in this federal program,” Gov. Brownback said in a statement after this week’s election. “My administration will not partner with the federal government to create a state-federal partnership insurance exchange because we will not benefit from it and implementing it could cost Kansas taxpayers millions of dollars.”

On Friday, a group rallying at the statehouse in Topeka urged Brownback to accept the federal expansion of Medicaid, something he has yet to decide.

In Missouri, meanwhile, Gov. Jay Nixon (D) would prefer to have a state-run insurance exchange but is prevented from submitting a plan to the US Department of Health and Human Services by next week’s deadline unless he gets legislative approval. Missouri voters this week approved a ballot measure prohibiting the governor from establishing an exchange unless it is specifically authorized by the state legislature or public referendum.

 "The only option for Missouri at this time is to indicate that we will be unable to proceed with a state-based exchange absent a change in circumstances," Gov. Nixon said at a news conference. But he added: "Let me be clear that a federally facilitated exchange is not the ideal approach. Regulating the insurance market is a power best left in the hands of the states."

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