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Obamacare won't be repealed. States now must act.

As House Speaker John Boehner said this week, the presidential election confirms that the Affordable Care Act 'is the law of the land.' But the fight over 'Obamacare' is not over as states decide whether to craft their own insurance exchange program or leave it to Washington.

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Supporters of the Affordable Care Act rally in front of the US Supreme Court in Washington in March as the court heard arguments on the health care law signed by President Barack Obama.

Charles Dharapak/AP

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Mitt Romney declared many times during his campaign that he’d “repeal Obamacare on day one” of his presidency. But as House Speaker John Boehner said this week, “the election changes that.”

The 2010 Patient Protection and Affordable Care Act – “Obamacare,” as everyone now calls it – is designed to extend health coverage to more than 30 million uninsured Americans beginning in January 2014.

Under the law, states must decide whether to expand their Medicaid coverage for low-income Americans (to be paid for by the federal government) and also whether to form health care insurance exchanges – an online marketplace where individuals and small businesses can shop for health insurance, presumably in a more competitive environment.

Sixteen states and the District of Columbia are on track to set up their own exchanges, while nine have decided they will not, according to an Associated Press tally. The federal government could end up running the new health care insurance markets in half or more of the states.

Americans for Prosperity (AFP), the conservative advocacy group linked to the Koch brothers, is pushing governors to resist the law’s Medicaid expansion and state-based insurance exchanges, reports The Hill magazine.

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