When Congress passed President Obama's health care legislation, one of the key points were the government-run exchanges. Obama envisioned these exchanges as "a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them." This legislation allows states to either establish their own insurance exchanges or allow the federal government to set one up.
Currently, many Republican governors are choosing the "neither" option. Or at least that is what they are currently divulging. Only 18 states have stated that they plan to run their own state exchanges. Another seven have decided on partnerships with the federal government, but that still leaves 25 states without exchanges. The White House announced this week that the previous deadlines for state decisions have been waived. The Obama administration wants as many states as possible to participate, so this decision makes sense. But they are unlikely to get many more states to set up their own state-run exchanges.
Many Republican states have said that they will not be participating. This could be political, as politicians do not want to be seen as supporting "Obamacare" in any way. It is, nonetheless, far from a "purely symbolic statement." When the legislation was proposed, it assumed that states would design and run many of these exchanges. The federal government does not want to implement these programs by themselves, as there are issues of cost to consider.
Obamacare is here to stay. But it could be damaged if states continue to reject their ability to create state-run exchanges, or at least partner with the federal government. The legislation's unpopularity with Republicans could still come back to haunt it.