The Patient Protection and Affordable Care Act remains a polarizing issue for many—and that becomes even more apparent when you look at how states are reacting to it.

After the Supreme Court upheld the law, about a third of the states told the Department of Health and Human Services they intended to create an exchange. Several states moved full-steam ahead with compliance even before the ruling. Some hailed the PPACA as a way to distribute health care to millions of uninsured and underinsured Americans.

But not everyone did.

Despite the positive ruling in June, it isn't all good news for the Obama administration. Health reform still lags 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 under way for a while.

That's in large part due to the fact that many of those states are just not that into reform. These states—led largely by Republicans—aren't rushing to comply.

Though there's a number of states that fall under both of these categories, here are five clear examples of each.

Five states resisting reform

1) Texas

Texas is among a chorus of states rejecting the two key proposals of the PPACA. Gov. Rick Perry—whose GOP presidential bid fell short earlier this year—said his state won't establish an exchange for patients to shop for insurance or expand Medicaid.

In a letter to Health and Human Services Secretary Kathleen Sebelius, Perry rejected both proposals.

“If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under Obamacare,” Perry stated. “I will not be party to socializing health care and bankrupting my state in direct contradiction to our constitution and our founding principles of limited government.

“I stand proudly with the growing chorus of governors who reject the Obamacare power grab. Neither a 'state' exchange nor the expansion of Medicaid under this program would result in better 'patient protection' or in more 'affordable care.' They would only make Texas a mere appendage of the federal government when it comes to health care,” Perry continued.

According to a Commonwealth Fund report, individual Texas health insurance premiums increased by almost 50 percent in the past eight years while the increase in family and group Texas health insurance plan premiums was even larger. The number of people uninsured in Texas is the largest in the nation, at 25 percent

2) New Jersey

Republican Gov. Chris Christie says he won't rush into setting up a New Jersey health insurance exchange just because the Supreme Court upheld the PPACA.

Instant Insights /

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