Only 15 states have fully cooperated with Obamacare by establishing state exchanges. From the CNBC story:
Only 15 states have told the federal government they plan to operate health insurance exchanges under President Barack Obama’s reform law, leaving Washington with the daunting task of creating online marketplaces for two-thirds of the country
Not all of this is protest, of course. Indeed, other states are setting up hybrid exchanges, and the number of states who go it on their own could rise to 18. plus the DC. But that makes for a difficult slog for the Feds:
But the administration would still be left to set up exchanges in at least 30 states, a challenge that is raising questions about how successfully U.S. officials can implement a key provision of the health care reform law.
State officials are very smart not to set up their own exchanges since any costs beyond what the Feds offer to help pay is on their taxpayers’ dimes. Moreover, since the Obama Administration has centralized control of setting minimum coverage standards–see the Free Birth Control Rule–the flexibility of states to regulate in this area is severely compromised. I mean, why take the potential blame if when things go badly when you don’t have a free regulatory hand?
If Obamacarians want more local cooperation, it seems to me that they will have to give up their ultimate control over state insurance markets. But Obamacare is a gargantuan power grab, so don’t look for that to happen anytime soon.