Texas' Battle Against Feds Leads to More Oversight

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Still, he said, if Washington puts together Texas' exchange it will almost certainly be "more progressive and liberal."

Faced with that possibility, some Republican governors hedged their bets. In Michigan, for example, Republican Gov. Rick Snyder indicated before Thursday's ruling that he would consider moving forward with his state's exchange so it could control its design. He said he was "just trying to be a pragmatist."

Perry declined Thursday to say whether he would ask lawmakers to create an exchange or move forward with implementation.

The U.S. Department of Health and Human Services is already running a federally mandated insurance plan that has about 5,700 Texans with pre-existing conditions participating, a transitional program that will be available until the exchange is in place. Other states have asked to run this program themselves.

Arlene Wohlgemuth, executive director of Texas Public Policy Foundation, a conservative think tank in Austin that includes health care as a focus, said there doesn't appear to be much of an advantage to Texas running its own exchange program because the law doesn't give states much room to tailor the programs.

"There was so precious little flexibility allowed that it really doesn't matter," she said. "We never saw any advantage in having a state do their own health care exchange."

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Associated Press writers Jamie Stengle and Nomaan Merchant contributed to this report from Dallas.

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