Even though the Supreme Court has not yet ruled on the legality of the health law, the overhaul continues to influence health policy in virtually every state -- but in very different ways. One example: the creation of health exchanges. The mix of politics, state-versus-federal powers, and the size and type of resources have created a mash-up of implementation efforts that one state health policy expert described as uniquely "50-state-ish."
Under the health law, these exchanges -- which will be open for business in 2014 -- offer the promise of one-stop-shopping marketplaces where millions of consumers and small businesses can go to buy affordable health coverage. They are one of the key mechanisms that facilitate the health overhaul's coverage expansion. For states that choose not to operate an exchange, the federal government would step in.
Some states have stood firm against the law and refused to take any action. Others have followed a go-slow approach -- waiting for the high court to send a clear signal. However, a handful have charged full-steam ahead, either moving the necessary authorizing legislation through state legislatures or by governors' executive order.
Kaiser Health News recently checked in with three states actively pursuing a state-based exchange. Commentaries follow from Rhode Island, Utah and Maryland. A common theme emerged: No matter how the court rules, change is not going to stop.