Medical-insurance markets crafted by four U.S. Republicangovernors won conditional approval by the Obama administration asthe federal government nudges states toward full implementation ofthe landmark health-care overhaul.

Idaho, New Mexico, Nevada and Utah are set to meet AffordableCare Act rules for marketplaces where residents can buy insurance,the U.S. Health and Human Services Department said in a statementtoday. The agency also approved plans in Democratic-led California,Hawaii and Vermont, bringing to 18 the number of states scheduledto run exchanges on Jan. 1, 2014.

“In all of these states there's more work to be done to be readyfor open enrollment in October, but we believe they've madesignificant progress,” said Gary Cohen, director of thedepartment's Center for Consumer Information and InsuranceOversight, on a conference call with reporters.

The exchanges will enable consumers to compare health plans andare a linchpin of the 2010 law's efforts to extend coverage tomillions of uninsured Americans. So far, 22 Republican governorshave said they'll refuse to participate, leaving it to the federalgovernment to set up markets in those states.

“One way or another there will be an exchange operating in everystate by October 2013,” Cohen said.

Enrollment in the exchanges must begin by Oct. 1 for plans thatwill take effect next year. The U.S. government plans to givestates that run their own exchanges a share of about $2 billion tohelp get them started. In addition to the 18 states, Washington,D.C., is building its own exchange.

As of now, the majority of the 50 states will either have to letthe U.S. run the markets or choose to provide services such asconsumer assistance in a partnership with the federal government.States have until Feb. 15 to enter a partnership.

Arkansas was approved today to operate a State PartnershipExchange. The health agency issued additional guidelines today onhow the joint exchanges will operate.

The department said it was taking no action yet on anapplication from Mississippi, where the Republican insurancecommissioner and governor are fighting over whether to go forwardwith an exchange.

Cohen said the department has no deadline for granting finalapprovals. States that opt out of running their own exchanges willhave another opportunity to apply in November, he said. Ifapproved, they'd take over in 2015.

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