By Michael Yudell

Right about now, somewhere in a state with Republican leadership, governors and their staff are likely staring at the calendar and wishing Mitt Romney had been elected President. You see, today was supposed to be the deadline for states to tell the Obama administration whether or not they will be forming their own health insurance exchanges, one of the key components of the Affordable Care Act (ACA) that will help provide health insurance for all Americans. In an 11th hour reprieve, the Obama Administration yesterday extended that deadline through December 14th.

From Florida to Virginia to here in Pennsylvania, some Republican governorsdelayed planning for the deadline (or rejected the exchanges and are now backtracking), hoping (against hope, as it turned out) that first the Supreme Court would overturn the Affordable Care Act. Didn't happen. And second, that Mitt Romney would be elected President and overturn to the Act. Didn't happen either.

Now many Republican governors are left with little time to do their due diligence and form the exchanges that would best serve their residents. According to, the exchanges "will allow individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children's Health Insurance Program (CHIP), and enroll in a health plan that meets their needs." But in the absence of state-run exchanges, the ACA allows the federal government to set up state-based exchanges.

Sarah Kliff, health blogger for the Washington Post, offers an interesting rationale for why, at this late date, Republican governors would allow the feds to step in to handle the exchanges (a move that seems contrary to much of the anti-government rhetoric they spouted when arguing against the ACA).

According to Kliff, "if the health insurance exchange malfunctions (and it might, given the time constraints), the blame lands squarely at your feet." So why take the risk at this point, especially when your state has done little or nothing to prepare? Instead, if theyare a success, then "perhaps the state even takes control of the exchange within a year or two. If it bombs, the finger-pointing is directed toward the federal government — and not at the governor." Today, Governor Scott Walker of Wisconsin became the latest to take his state down this road.

However, there have been cracks in the anti-ACA façade the last few days. Virginia Governor Bob McDonnell, whose state was the first to file a lawsuit against the ACA, has indicated that his state will develop its own exchange. And yesterday in Florida Governor Rick Scott, once a right-wing hero for his resistance to Obamacare, seems to have dropped his opposition to the ACA. "The election is over and President Obama won," Scott said on Tuesday, expressing his willingness to now have a "conversation" about the exchanges.

So after all the lawsuits against the Affordable Care Act (what do you think those cost taxpayers?), Obamacare is here to stay. The challenges of implementation now await us. There will be negotiations over the planned Medicaid expansion and there is the fear that some states may create barriers to Medicaid-eligible recipients. There are details to work out over putting into operation the health care exchanges. And in the wake of years of misinformation about the ACA (no, the ACA is not responsible for the growing doctor shortage in the United States, and, no, the ACA will not bankrupt small business), there is the urgent need to educate both individuals and businesses about what the law will mean for them and how to navigate its provisions.

If you have questions about how the new law might affect you, you can read all about it at

Read more about The Public's Health.