“Another Republican governor on Tuesday formally refused to set up an insurance exchange under President Obama’s healthcare law. Alabama Gov. Robert Bentley said the state will not establish an exchange and also will not participate in the law’s Medicaid expansion.”

“While the future of the 2010 health care law stabilized with the re-election of President Obama, both Democrats and Republicans say now is the time for them to come together to fix it… Until Tuesday, when Obama’s future was determined, Republicans opposed to the law waited for a change in administrations that would allow them to repeal the law. That will not happen now with a Democrat in the White House for the next four years… But changes are imminent.”

“The Democrats do not have supermajority control of the House and Senate, as they did in the 111th Congress when the PPACA was passed. Indeed, in 2013 and 2014, Republicans will have a rather sizeable majority in the House, along with 45 votes in the Senate. In addition, there are now 30 Republican Governors in the states, who will have much to say about health care policy in the coming years, too. So, unlike the birth of the PPACA, its implementation will proceed at a time when Republicans are controlling many levers of power.”

“President Obama has won reelection, and his administration has asked state officials to decide by Friday, November 16, whether their state will create one of Obamacare’s health-insurance ‘exchanges.’ States also have to decide whether to implement the law’s massive expansion of Medicaid. The correct answer to both questions remains a resounding no.”

“By the end of this week, states must decide whether they will build a health-insurance exchange or leave the task to the federal government. The question is, with as many as 17 states expected to leave it to the feds, can the Obama administration handle the workload.”

“Voters in Missouri approved a measure Tuesday that will hamper its governor’s ability to implement President Obama’s healthcare law. The law will prohibit the governor from creating an insurance exchange unless the move is authorized by the state legislature or by a ballot initiative. Given the makeup of the statehouse, the measure’s approval Tuesday all but ensures that Missouri will have a federally run exchange.”

“November 16th is the deadline for states to submit a blueprint to the federal government for Obamacare’s insurance exchanges — a key component of the new healthcare law. Already, the exchange system is proving to be an unmitigated disaster. No one should be surprised by this. Like so much of the president’s gargantuan healthcare entitlement, the exchanges are burdened by a spider’s web of confusing regulations, poor design, and a top-down, command-and-control structure.”

“Early this morning, the Hill reported that the Obama administration’s Department of Health and Human Services (HHS) is relying on a private company — a subsidiary of UnitedHealth Group — to play a central role in establishing and running Obamacare’s insurance ‘exchanges.'”

“The Obama administration is relying heavily on outside contractors to implement a core component of healthcare reform as it races to set up a federal health insurance marketplace before 2014. The fast-approaching deadline gives the administration little time to scrutinize private-sector partners for conflicts of interest. The purchase of one of these contractors, Quality Software Services, Inc. (QSSI), by UnitedHealth Group, a major healthcare conglomerate, has sparked concerns about a potentially uneven playing field.”

“As the federal government tries to leave the states with the freedom to set up individualized local health exchanges, state officials say they’ve received so little guidance that they’re afraid they’ll have to make changes as more regulations come out after the presidential election.”