Several state governors are in defiance of the health care reform law by not creating a state insurance exchange. The governors say the U.S. Department of Health and Human Services has not provided them enough information to proceed. Despite that claim, 17 states have begun building their exchanges with pledges to do so from another six. The reluctance to establish an exchange is puzzling to many. The government will set up an exchange for any state that does not, and any costs associated with setting up the exchange will be paid for by the government.