The American Legislative Exchange Council, the Cato Institute and other conservatives say the federal government will be unable to implement the 2010 health care law without state exchanges. Ten states have delayed acting on exchanges after conservative organizations canvassing the country persuaded them to, according to ALEC. “I’m a conservative and a Republican, but I still would not be willing to bet the farm on” the idea that the law will fail if states don’t create exchanges, said Cheryl Smith of the exchange practice of Leavitt Partners. “States are implementing the health care law,” said Erin Shields, spokeswoman, Health and Human Services. “Two-thirds of all states have received federal grant dollars to establish affordable insurance exchanges, and states have the flexibility they need to build an exchange that works for them. On Jan. 1, 2014, consumers in every state will have access to an exchange.” 

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