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Republican-led states brace for Oct. 1

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RALEIGH, N.C. (AP) — Officials in states with Republican governors who have stood firm against the Patient Protection and Affordable Care Act (PPACA) exchange program — or have decided to participate — are waiting to see what happens tomorrow.

In Nevada, Republican Gov. Brian Sandoval is overseeing the creation of the Silver State Health Insurance Exchange, which is set to offer a total of four carriers.

Republican officials in Utah will be letting the U.S. Department of Health and Human Services (HHS) run the state’s individual exchange program.

Governors in many other Republican-led states have reacted to the exchange program with strategies ranging from all-out opposition to cold charity.

Republicans in the U.S. House and Democrats in the Senate are in a government shutdown budget battle that could have effects on the start of the exchange program that are hard to predict.

In Utah, federal officials have already poured about 2 million in grants into navigator training and public awareness programs.

In Nevada, exchange officials have postponed until November an aggressive television ad campaign urging people to sign up. Instead, they’re hoping for a “soft” launch of the exchange so they have time to identify and fix any lingering problems before the sign-up deadline nears and more web traffic is expected.

Meanwhile, Republican officials in some other states are doing what they can to stop the start of the exchanges, or to close the exchanges if they do start up.

Missouri bars state employees from helping implement an insurance exchange, leaving it entirely to federal direction. Last week, Missouri Lt. Gov. Peter Kinder this week urged Missouri residents to resist the federal law by refusing to sign up for health insurance. They could be forced to pay a fine of $95 or more if they don’t.

“I don’t see any reason to enable the implementation of this law,” Kinder said. “I think the whole thing is in the process of collapsing.”

The Florida Department of Health recently ordered county health departments across the state to ban navigators from conducting outreach on their property. Florida has one of the highest uninsured rates in the country with an estimated 3.5 million lacking insurance.

“When it came to Obamacare, we didn’t just say ‘no,’ we said ‘never,’” South Carolina Gov. Nikki Haley said last month alongside U.S. Sen. Tim Scott, whom she appointed last December when Jim DeMint resigned. “And we’re going to keep on fighting until we get people like Sen. Scott and everybody else in Congress to defund Obamacare.”

North Carolina is among the states that have left the running of its exchange to HHS. This year, the state refunded what remained of a $74 million federal grant that would have helped consumers and linked computers.

But, even in the Carolinas, some officials have grudgingly made moves to try to lessen PPACA-related disruptions.

North Carolina Gov. Pat McCrory’s health agency recently urged county social services departments to discuss the insurance exchanges when people come in seeking food stamps or child care help. The Republican governor’s administration also encouraged social services agencies to offer space as available to navigators.

In South Carolina, which also left advertising and running the exchange to the federal government, the state Medicaid agency ramped up its call center to handle 50 percent more calls as people have questions about the law, deputy director John Supra said.

In Florida, Broward County commissioners last week ignored the state-imposed ban on letting PPACA navigators into county health departments and voted to let navigators and other exchange outreach workers enter county offices, including health departments.

‘We’ve encountered many, many issues with this, and this is a breakthrough for us to be able to go into the libraries, the health departments,” said Jerson Dulis, who was trained to help enroll people in the state exchange. He works for Broward Community & Family Health Centers Inc., which received a federal grant to provide consumers understand and enroll in health insurance plans.

The Republican governors in states like South Dakota and Pennsylvania have taken a more neutral approach to the exchanges.

In South Dakota, the state Division of Insurance has certified Avera Health Plans, Sanford Health Plan and Dakotacare to offer plans, said Melissa Klemann, the division’s assistant director of life and health insurance.

South Dakota is not putting any resources into marketing the health exchange. Klemann said she’s not sure whether residents will flock to the site Tuesday or whether traffic will build over time.

“I think we’re all anxious to see what that Oct. 1 date will do,” Klemann said.

In Pennsylvania, Gov. Tom Corbett’s administration has remained on the sidelines. His administration spent virtually nothing to the exchange program and received nothing from the federal government to market it, either.

But Antoinette Kraus, director of the Pennsylvania Health Access Network, a group of about 60 organizations that is helping lead the enrollment effort in Pennsylvania, noted that the Corbett administration has not sought to block efforts to educate or enroll people, as some states have actively done.

In Indiana, Republican Gov. Mike Pence has been no fan of PPACA. Last year, he equated the Supreme Court ruling upholding part of the law with the Sept. 11 terrorist attacks. However, his new administration has still been working to provide some key backup ahead of the opening of the exchange.

The state has hired, temporarily, 150 new caseworkers to handle an expected spike in residents seeking Medicaid coverage via the “woodwork effect” — an increase of enrollees. The state also has run tests on its phone system to ensure it will be able to handle call volumes.

Allison Bell and Associated Press writers Kelli Kennedy in Miami; John Milburn in Topeka, Kan.; Seanna Adcox in Columbia, S.C.; Scott Bauer in Madison, Wis.; Dirk Lammers in Sioux Falls, S.D.; Marc Levy in Harrisburg, Pa.; Sandra Chereb in Carson City, Nev.; Tom LoBianco in Indianapolis; Bob Christie in Phoenix; and Michelle L. Price in Salt Lake City, contributed to this report.

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