Before Health Exchange Deadline, Perry Reaffirms Stance

That means the federal government will have to roll out a program for Texas instead. Every state must have an exchange by 2014, the year "Obamacare" -- which many Republicans had hoped would be repealed if Mitt Romney won the presidency -- requires most Americans to carry coverage.

Allison Castle, Perry's spokeswoman, said Texas won't design its own exchange because there is "really no such thing as a 'state exchange.'"

"This is a federally mandated exchange that must be approved by the Obama administration, and will dictate the rules states must follow," she said. "Texas will not be a subcontractor to Obamacare."

Supporters of the exchange, considered crucial to getting the quarter of Texans who are uninsured to sign up for coverage, say the move is short-sighted -- and a result of Republican state leaders playing politics over health policy. State Rep. Garnet Coleman, D-Houston, who was in Washington, D.C., meeting with the Obama administration's Medicaid chief on Thursday, said thankfully there's a backstop: a federal exchange.

"I'm ready, and I'm sure other people are ready, to work with the federal government to do the best exchange that we can in Texas," Coleman said, adding, "Guess what? One monkey don't stop no show."

According to The New York Times, 17 states and Washington, D.C., will create their own insurance exchanges; other options include partnering with the federal government to create an exchange, or letting the federal government implement a more one-size-fits-all plan.

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