Republicans want local, not federal, control; so, why are so many Republicans refusing to run state exchanges as they are permitted to do with the Affordable Care Act. Jonathan Bernstein:
Remember that under the health law, state governments will set up on-line insurance marketplaces so that those without insurance can easily compare and purchase the private-market package best for them. The law did allow for states to opt out, in which case the federal government would do it for them. Now, normally Republicans would assure us that the states do a better job of running things than the federal government in Washington, especially states with Republican governments. The key, however, is that they simply don't want this policy to work, so they're simply refusing to implement it: The latest in the GOP scorched earth policy on health care, now that it's been defeated everywhere else.