Mississippi
Mississippi is the only state in the country to have a proposal for an exchange rejected by the federal government. This was a fascinating outcome considering how badly the Obama administration wanted Republican-led states to run their own exchanges. The debate in Mississippi was unique because an independently elected Republican insurance commissioner believed he could establish an exchange without his governor’s support. It seemed he would be able to—until the Tea Party joined the fight, with the support of national and state-level conservative think tanks. They made their presence felt at obscure meetings in highly technical parts of the process. Fellow-Republican Governor Phil Bryant then put his foot down and said no exchange would be created in Mississippi without his support. The Obama administration may have been tempted to approve the exchange anyway, but decided to stay out of the intrastate fight.