Decision day for states on health exchanges

WASHINGTON -- Nineteen states have turned down the Obama administration's invitation to run the new health insurance markets that will begin serving millions of uninsured Americans less than a year from now. That puts a huge task on the feds, a defining challenge for President Barack Obama's second term.

Today is decision day for states to notify Washington if they will set up their own insurance exchanges under the federal health care law. Monitoring by The Associated Press finds a divided nation moving ahead, despite the misgivings of some state officials. Half the states now say they will participate in some way.

Still, drafters of the law did not anticipate that so many states would remain on the sidelines at this late stage. Federal control of the new state markets, where individuals, families and small businesses will shop for taxpayer-subsidized private coverage was seen as a fail-safe, not the standard for nearly half the country. Critics predict delays.

All of the states refusing are led by Republicans.

Seventeen states and Washington, D.C., say they want to run their own markets. The administration has already started granting approvals. Eight other states have indicated they want to pursue a partnership with Washington, and more may do so. Six remain undecided.

Exchanges are the gateway to the new health care law for individuals and families who buy their own health insurance, as well as for small businesses. -- AP