One of the best reasons for the states refusing to implement the Obamacare health insurance exchanges is that the Obamacare law provides no provision for subsidizing insurance policies through the federal exchanges. If the states don’t set up the exchanges, the federal government cannot disperse the subsidies and tax credits that are a key element of the overall law.
Except, the Obama administration has decided they’re just going to ignore that provision of the law and do an end-run around the states refusing to implement the exchanges and at least one state is taking the feds to court over it:
Federal bureaucrats have already begun rewriting the law when the provisions of the actual statute prove inconvenient. When it became obvious that many states would refuse to create exchanges, the Obama administration decided to funnel tax credits and subsidies through federally-created exchanges, ignoring clear language in the law indicating that such premium-assistance was restricted to state-run exchanges. The IRS recently finalized a regulation signaling its intention to illegally provide premium assistance through federal exchanges.