The Obamacare plot twist

But that assumes that states implement it in good faith. The staunch opposition of Republicans has meant that many states with little regulation of insurance companies or healthcare are delaying or actively resisting many aspects of the bill. What’s clear is that opposing the bill is a good strategy if you want the reforms to fail. The success of the legislation depends on the cooperation of state governments, insurance companies and federal regulators. That is hardly unusual, but the complexity of the reforms make it all the more imperative.
Yet the divergences over the bill and its consequences mask a rather severe rift between federal actions, state conviction and popular opinion. Despite laws passing at the federal level, the reality is that the United States remains a federal system that requires vast efforts of compliance by states and by individuals. One of the great gripes of state-level politicians is that Washington is forever passing “unfunded mandates” and assorted vague and complex laws, and then leaving it to states to pay for and figure out the implementation. The Affordable Care Act is Exhibit A for these tensions.

http://blogs.reuters.com/edgy-optimist/2013/07/18/the-obamacare-plot-twist/