In Indiana, Gov. Mitch Daniels issued an executive order that allowed the state to become one of just three to receive a multimillion dollar grant to establish a health exchange, the online insurance marketplaces that all states must eventually have if the reform law stands up in court.
Wisconsin, under the leadership of Gov. Scott Walker, is one of six states to win an Early Innovator grant. While the grant was received under Walker’s predecessor, Gov. Jim Doyle, Walker has continued to use the resource, setting up the Office of Free Market Health Care that has prominently advertised its innovator status.
And in a weird twist of politics in Mississippi, state agencies of Gov. Haley Barbour have relied on little-used statutory authorities to set up an exchange, reviving a Democratic-sponsored effort to do so through the Mississippi State Legislature.
Daniels, Walker and Barbour are a stark contrast to Republican governors who are more stridently opposed to all aspects of health reform. Govs. Rick Scott of Florida, Bobby Jindal of Louisiana, and Susana Martinez of New Mexico have come out in fierce opposition of any kind of implementation.
Scott and Jindal have also shunned federal money to plan their exchanges.
“The Rick Scotts of the world are probably going to be in the minority,” says one Republican health policy source, referring to the Florida governor’s halting health reform implementation. “The ones that block it fundamentally have a disagreement or it fits into a broader political calculus.”
Many strategists in D.C. contend that setting up the exchanges undermines Republicans’ constitutional challenges to the health reform law.
But having a handful of prominent Republican governors move forward on the issue — two of whom weighed presidential runs — suggests that the exchanges could emerge as one of the more palatable provisions of the contentious law.
And still other Republican governors, with smaller national profiles, have also endorsed implementing state-run health exchanges.They include Nevada’s Brian Sandoval, who is backing an exchange implementation bill in the Nevada State Legislature, Georgia’s Nathan Deal and Virginia’s Bob McDonnell.
“The big picture is that, while there’s an ideological divide, many governors see the exchange as an empty vessel they can shape in their own image,” says Ian Morrison, an independent health policy consultant in California. “Republican governors like the idea of more commercials insurance.”
Another crucial factor at play: If states don’t set up their own exchanges by 2014, the federal government will come in and do it for them.