New Hampshire's House just passed a bill that would prohibit lawmakers from creating laws to enact exchanges. The law was written by Republican Rep. Andrew Manuse, who said the federal law relies on state resources, including money, to create exchanges.
Manuse has worked with Cato and ALEC, he told USA TODAY, and said the federal government is not ready to implement the exchanges.
"They did not prepare for the possibility that the states would reject the exchanges," he said. "Not setting up an exchange is the best way we can work toward making the law be amended or repealed."
However, the law included money to pay for building the exchanges, for which the government is already paying for the states' planning stages.
"States are implementing the health care law," HHS spokeswoman Erin Shields said. "Two-thirds of all states have received federal grant dollars to establish affordable insurance exchanges, and states have the flexibility they need to build an exchange that works for them. On Jan. 1, 2014, consumers in every state will have access to an exchange."
"The states need to set up legislation to protect themselves," said Cheryl Smith, director of the exchange practice portion of Leavitt Partners, a health care operation run by former Utah governor Mike Leavitt, a Republican who was President George W. Bush's secretary of Health and Human Services. "I myself have a lot of problems with the Affordable Care Act, but why not a sunset clause?" she said.
Before the health care law was passed, Smith said, she was working with 22 states to create exchanges, which she called a Republican idea.
"I'm a conservative and a Republican, but I still would not be willing to bet the farm on" the idea that the law will fail if states don't create exchanges, Smith said. "When you work at a think-tank, it's really easy to come up with these really high-risk plans."
No Republican alternative to the health care law has been announced.
States are still working on exchange plans, Smith said, and are accepting grants, hiring directors and creating plans. Regardless of the Supreme Court's decision, she said, states will be ready with special sessions or executive orders.