The nine definitely not setting up exchanges are Alaska, Florida, Louisiana, Maine, New Hampshire, South Carolina, South Dakota, Texas and Wisconsin. Missouri and others are likely to join the list.
As far as Medicaid, 11 states and the District of Columbia have indicated they will expand their programs, while six have said they will not. That leaves more than 30 states undecided.
The states definitely expanding Medicaid include California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, New York, Vermont, and Washington. Those declining include Florida, Georgia, Louisiana, Mississippi, South Carolina, and Texas.
On Capitol Hill, Republicans say if a budget deal is going to include tax increases, it must also come with cuts to the health care law, or money-saving delays in its implementation.
While major changes can’t be ruled out, they don’t seem very likely to former Senate Majority Leader Tom Daschle, D-S.D., who is close to the administration.
‘‘I think Democrats are increasingly emboldened about the health care act,’’ Daschle said. ‘‘The president won re-election partly by defending it. There is a new dynamic around the health care effort.’’
Republican attempts to amend the law will continue, he added, but outright repeal is no longer a possibility. ‘‘Budgetary issues will continue to be a big question mark,’’ said Daschle.