Six statesare in the process of shifting to state marketplaces in hopes ofachieving cost savings, improved customer experience and greatercontrol over health care plans. (Photo: Getty)

Just as a number of states that previously declined federalfunding to expand Medicaid have since reversed, some stategovernments are beginning to assume greater oversight of theirstate's health care marketplace.

When the Affordable Care Act was launched six years ago, stateshad a decision to make: Would they set up their own insurance marketplaces or would they leave thatto the federal government?

Originally, only 17 states set up their own marketplaces. In thefollowing years, some retreated and handed off control to the feds.Now, only 11 states and the District of Columbia operate their owninsurance exchanges, according to an analysis from theRobert Wood Johnson Foundation.

Related: New 'super broker' system cuts HealthCare.gov outof the ACA signup process

In many cases the decision to use the federal marketplace had asmuch to do with politics as policy: Republicans, who were incontrol of most state governments, viewed setting up their ownexchange as an endorsement of the ACA.

It also isn't all-or-nothing. There are currently only 17 statesthat have relinquished entire control of their marketplaces to thefeds.

Another 17 states have "State Partnership Marketplaces" wherethe state oversees management of insurance plans and providescustomer assistance but the feds are in charge of all remainingfunctions. Five states have "State-based Marketplace-FederalPlatforms," (SBM-FP) where the state is responsible foradministering the marketplace but customers enroll in plans via thefederal HealthCare.gov.

Now, six states are in the process of shifting to statemarketplaces in hopes of achieving cost savings, improved customerexperience and greater control over health care plans.

Maine, New Jersey and Pennsylvania are transitioning frommarketplaces that are entirely operated by the feds to SBMs. Theyplan to complete the transition for the 2021 plan year.

Nevada, New Mexico and Oregon are switching from SBM-FPs toSBMs. Nevada will switch for the upcoming 2020 plan year, while NewMexico is planning to switch by the 2022 plan year. Oregon'stimeline remains up in the air.

Some of these changes are due to a shift in political control.Maine, New Jersey, New Mexico and Pennsylvania had Republicangovernors during the implementation of the ACA but now haveDemocratic governors, although Pennsylvania still has aGOP-controlled legislature.

Nevada and Oregon originally put in place state-basedmarketplaces but relinquished control due to technical issues. Nowboth states are going to give SBMs a second try.

The election of Donald Trump has given Democratic stategovernments an additional incentive to take over. The Trumpadministration has sought to undermine the ACA by reducing theenrollment period and cutting funding for the marketing of themarketplace.

Read more:

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• CMS star rating plan expanding to all ACAexchanges
• 5 states of 2017 ACA exchange ratedata