In a letter posted Nov. 2nd, the National Governors Association submitted a letter to U.S. Health Secretary Kathleen Sebelius, stating that the federal health care law’s exchange mandate could limit states’ autonomy, and requesting that the federal government take over certain elements of its administration, including facilitating advance payment of premium tax credits to insurers. The law gives states a wide berth to establish their own health care exchanges, partner with neighboring states, or step back and make a federally-run exchange available to residents. This wide range of choices has left states uncertain as to what their next steps should be; many are scrambling to build computer systems, hire staff, and design an exchange from scratch. 

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