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State's plans for health care exchanges vary

ST. PAUL -- Few states are as far along as Minnesota in establishing a state-based health insurance exchange program, and at last report only 17 have decided to set them up.

Six states have opted to work with the federal government to set up exchanges and 16 will leave it up to the federal government. The other 11 states have not announced their plans.

The exchanges, due to come on line in 2014, would give uninsured Americans a place to compare and buy health insurance policies. If states do not set them up, the federal government will.

Most Republican governors have said their states will not take part, citing objections to the Affordable Care Act in general.

GOP governors told Democratic President Barack Obama shortly after the election that they wanted to meet with him because Obamacare would be "an enormous strain on state governments and budgets."

A recent Associated Press poll showed 63 percent of Americans would rather that states run the exchanges.

Republican governors in three states adjoining Minnesota opted against establishing a state-based health exchange.

Kaiser Health News ( follows each state's efforts:

North Dakota

Republican Gov. Jack Dalrymple announced in November the state will not establish its own exchange. The Legislature earlier had declared the state's intent to begin an exchange.

South Dakota

Gov. Dennis Daugaard announced in September that the state will not begin an exchange. The decision was based, in part, on the annual operating cost of a state-based insurance buying service.


Terry Branstad is one of a few Republican governors who plan to proceed with work on an exchange. However, he said, because of lack of federal guidance and time, Iowa may rely on a federal exchange at first.


Gov. Scott Walker announced in July that his state would not take part. Wisconsin started work on setting up an exchange in 2011, but that stopped with Walker's July decision.

Don Davis
Don Davis has been the Forum Communications Minnesota Capitol Bureau chief since 2001, covering state government and politics for two dozen newspapers in the state. Don also blogs at Capital Chatter on Areavoices.