Some states have opposed health reform by pressing for largely symbolic ballot measures to record opposition to the federal mandate to purchase health insurance, and in many cases, suing in court to block the mandate. Texas, despite the opposition to health reform from Gov. Rick Perry and Republicans in the state legislature, has been preparing itself to make the most of health reform. Now, Gov. Tim Pawlenty of Minnesota -- a potential GOP presidential candidate for 2012 -- has signed an executive order restricting the state's ability to pursue federal money to help with the some of the implementation of health reform, according to this story in The Wall Street Journal.

Pawlenty's order only lasts for the duration of his term, which is up around the end of the year. It's unclear just how much the executive order will affect Minnesota's efforts to implement health reform in comparison with other states that have not made efforts to throw up roadblocks. Some argue that Pawlenty's order is purely a political move that won't have a substantial impact. But, Pawlenty doesn't want the state to participate in the demonstration projects -- which are designed to find ways to lower the cost of health care delivery -- or to pursue federal help with the development and implementation of the insurance exchanges. In fact, he told The Wall Street Journal he would do all he could to keep the state from setting up an insurance exchange before the 2014 deadline.

The exchanges are a key part of health reform because they attempt, for the first time, to establish a central clearinghouse where consumers can determine their options and shop for the best deal among competing health plans. They combine market forces with federal government subsidies to help lower-income people afford their premiums. States that have been proactive in implementing health reform, including Maryland, are about to turn in their applications for grants to help them design exchanges.

Because states have so much responsibility in implementing reform, Pawlenty's actions -- despite his departure from office at the end of the year -- could have a substantial impact. Will any other governors with more time left on their terms use similar tactics to oppose health reform? If so, there could be wide disparities among states -- and their populations -- in terms of their preparedness to get the most out of health reform. The clearest indicator may be the number of states that submit their grant applications on time.

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