Obamacare needs more than the Supreme Court's approval this summer. It also requires states to organize "exchanges" where people can buy health insurance—but 75% of uninsured Americans live in states that are yet to get cracking, the AP reports. Some states, like Florida and Louisiana, have flat-out returned federal dollars for the program as part of GOP opposition to Obamacare. But 16 others are paralyzed by a lack of legislation or partisan bickering.
The irony: States that don't get organized by Jan. 1, 2013, will relinquish their health care power to the feds. "It's pretty hard to take care of the states when they don't take care of themselves," says Nebraska Sen. Ben Nelson, who fought for states' right to create their own exchanges. But it's no cakewalk for the feds, who would need to set up elaborate infrastructures to approve insurance buyers. "It's a very heavy lift," says California's health secretary, Diana Dooley. "Coverage is certainly important, but it's not the only part. It is very complex."