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July 18, 2011: Gov. Rick Perry signs health care reform bill into law; Texas fourth state to pass health care compacts bill

"With the signature of Gov. Rick Perry today, Texas has joined three other states stating their intention to enter into a health care compact.

The compact, which would challenge the authority of the federal government to dictate the terms of the federally and state funded Medicaid program, was part of a wide-ranging health care reform bill, Senate Bill 7, passed by the Texas Legislature in its recently concluded special session.

Georgia, Oklahoma and Missouri have already signed onto the compacts movement, with Missouri Gov. Jay Nixon signing a bill into law on Thursday.

The law establishes Texas, along with the other three states, as pioneers in an uncharted use of Article 1, Section 10 of the Constitution which allows states to enter into agreements that, with the approval of Congress, cannot be abridged by the federal government. There are more than 200 state compacts currently in effect, nearly all of them related to commerce.”…..

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August 8, 2011: Kansas returns health insurance exchange grant WASHINGTON, Aug 9 (Reuters) - Kansas became on Tuesday the second U.S. state to return a large federal grant meant to help it create a prototype health insurance exchange as part of the Obama administration's healthcare overhaul.

Republican Governor Sam Brownback said the state would give back the $31.5 million it received from the U.S. Department of Health and Human Services to become an early leader, along with six other states, in establishing health insurance exchanges that other local government could use as a model.

Exchanges are meant to provide an open marketplace of competing insurance plans that allow uninsured people and small businesses to band together to negotiate cheaper rates.

Kansas's move brings the total amount of the returned exchange-related federal grants to almost $90 million as Republican governors seek to block implementation of the healthcare law supported largely by Democratic lawmakers.

Experts warn that many states are falling far behind schedule for a smooth and timely roll-out of the reform.

States are facing a deadline of Jan. 1, 2013, to submit detailed plans for their exchanges or see HHS come in and build one itself. Returning grants increases the likelihood that HHS would have to do the work.

"It could come around to hurt the state in the long run," said Sabrina Corlette, a research professor at the nonpartisan Health Policy Institute at Georgetown University.

"The more states that say: 'Forget it, let's have the Feds run it,' the more likely the (federal government) is going to have a one-size-fits-all solution. They're not going to be able to customize it for 30 states."

In April, Oklahoma returned its $54.6 million early innovator grant, the largest of the batch of seven issued in total. Kansas followed suit on Tuesday after months of internal wrangling between Insurance Commissioner Sandy Praeger and the conservative governor and legislature.

"Every state should be preparing for fewer federal resources, not more," Governor Brownback said in a statement. "To deal with that reality, Kansas needs to maintain maximum flexibility. That requires freeing Kansas from the strings attached to the Early Innovator Grant."…………….

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MEANWHILE MITT ROMNEY is pushing these health care exchanges

July 16, 2011: Romney Adviser Backs Obama Health Exchanges

SALT LAKE CITY — Former Utah Gov. Mike Leavitt, a top supporter and adviser of Republican White House hopeful Mitt Romney, strenuously backed the core piece of President Barack Obama’s health-care law and urged the states to move forward together in adopting health insurance exchanges.

Speaking to a bipartisan group of governors at the National Governors Association, the former Republican governor who served as secretary of health and human services in the Bush administration, called the exchanges where individuals and small businesses can purchase health plans “a very practical solution to a problem that needs to be solved.” He warned governors who are reluctant to move forward with their state-level exchanges that their intransigence will only empower federal regulators.

And he said the health care law that passed is a compromise that gives the states the flexibility they need.

“This is a profoundly important time for the states,” said Mr. Leavitt. “States need to lead.”

The comments came at a time when every major Republican presidential candidate has pledged to repeal the Affordable Care Act, the president’s health care law. For former Massachusetts Gov. Romney, the issue is extra sensitive: the health care plan he secured for Massachusetts included an exchange almost identical to the federal law. He has tried to tightrope through the issue, blasting the federal law as he defends his own.

The federal law gives the states until January 2014 to set up their own exchanges, with federal oversight. If they fail to do so, their citizens will get access to a federal exchange.

But some Republican governors have been reluctant. They oppose the federal law and say they hope it will be repealed by a Republican president in 2013.