Obamacare: Some GOP Governors Likely to Implement it if Supreme Court Upholds Health Care Law

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The fate of Obamacare -- the health care law championed by the White House -- is with the Supreme Court, which is expected to hand down a decision this month. If -- and it's a big if -- the court rules fully in favor of the law and its requirement that the government can require Americans to buy health insurance, it will put some Republican governors in the uncomfortable position of working with the federal government to implement a law they dislike.

Take Chris Christie, the Republican governor of New Jersey.

Democrats in the New Jersey legislature can expect him to work with them on implementing a state-regulated health insurance exchange, something is required under the health care law.

Part of the law requires that individuals buy medical insurance by 2014, but when they do, people and small businesses can purchase subsidized insurance through state-regulated exchanges.

Christie vetoed a measure in New Jersey to create exchanges back in May, but sounded grudgingly receptive to future action in his veto message to the state's general assembly. As governor, he applied for and accepted $8 million in grants from the Department of Health and Human Services to set up an exchange.

"While I am unwilling to approve the establishment of a statewide health insurance exchange at this time, I am mindful that the requirements of the Affordable Care Act still stand today and I intend to fully oversee New Jersey's compliance in a responsible and cost-effective manner should its constitutionality ultimately be upheld by the Supreme Court," said Christie in a letter to the New Jersey General Assembly.

Christie, regarded as moderate on many issues, has established himself as a Republican willing to fight the federal government. He has rejected federal money on numerous occasions. Still, many Governors, like Christie, have accepted federal grant money and are preparing to meet the 2014 deadline in the health care law.

"I don't think he's also going to stand as obstructionist for a law that has been passed by Congress and upheld by the Supreme Court," said Ben Dworkin, the director of the Rebovich Institute for New Jersey Politics at Rider University.

Still, conservative activists are watching to see what Christie and other governors do. Some are concerned that governors will allow Obamacare provisions to pass at the state level.

"I only hope that we can we can explain these different things to him and to educate his staff on why it's economically beneficial not to implement this in New Jersey," said Steve Lonegan, the New Jersey State Director at Americans for Prosperity, a conservative group founded with support from David and Charles Koch.

Christie probably won't be alone among Republican governors, who may have to scramble to implement the law if the Supreme Court lets it stand. If states don't establish their own programs by 2014, the law allows the Federal Government to intervene with its own health exchanges. Most states have applied for federal grant money but only a few are close to implementation.

New Mexico Gov. Susana Martinez, like Christie, and has vetoed legislation in her state, citing the pending Supreme Court decision as a reason to delay. But Martinez has also accepted federal grant money. New Mexico will receive $34 million from HHS to establish its insurance exchange.

"I am in general support of the creation of a framework to establish a state insurance exchange because I believe it is important that New Mexico maintain control over the design of a market-based exchange, instead of allowing the federal government to define the process," said Martinez in her veto to the state legislature.

Gov. Mitch Daniels of Indiana went even further when he issued an executive order last year to establish insurance exchanges. His state is getting $6.8 million from HHS. Republicans control the Indiana State Legislature.

Where does Mitt Romney stand on exchanges?

Romney has repeatedly said he is "for repealing Obamacare on day one." But his newly minted transition head, Mike Leavitt, has no problem with the concept of state health insurance exchanges, according to Politico.

"We believe that the exchanges are the solution to the small business insurance market and that's gotten us sideways with some conservatives," he said.

Massachusetts is one of two states that have state health insurance exchanges. Romney is largely tied to the healthcare law that gave birth to those exchanges and Leavitt, a former Utah Governor and former head of HHS under George W. Bush, benefited financially when his firm received a contract to build Utah's exchange program.

If Romney is elected in November he will likely work with Congress to repeal and replace the Obama health law with his own healthcare plan. On Romney's website there is a healthcare page that mentions his plan to "Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies."