Governors in Texas, Florida and elsewhere have refused to set up insurance exchanges under the Affordable Care Act, Missouri voters passed a ballot measure prohibiting the state from doing so without the Legislature's approval, and some states are considering running their exchanges in partnership with the federal government. Officials in other states, such as New Jersey and Virginia, have laid the groundwork for insurance exchanges but were waiting to announce plans until after the election. Leaders of 11 states and Washington, D.C., said they will expand their Medicaid programs, six said they won't, and some are negotiating with HHS on the scope of expansion.

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