The Patient Protection and Affordable Care Act has been a polarizing issue for many—and that's apparent when you look at how states are reacting to health care reform.

Despite the Supreme Court ruling upholding the law last month, it isn't all good news for the Obama administration. Health reform is lagging in several states. Half now face a federally run health care exchange, the default for states that haven't made progress or declined involvement in setting up a state run marketplace for health insurance coverage.

Officials at the National Association of Insurance Commissioners even warn it's too late to start a state-based exchange if work hasn't already been underway for a while.

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