Federal officials are currently anticipating they'll have to run health insurance exchanges for lots of states - "as high as 30," Joy Wilson of the National Conference of State Legislatures told Idaho lawmakers this morning. "And that means that there won't be much customization. So there'll be a template and this is how they'll do it. So if you have particular issues in your state, whether it's geography or special populations or just something that is unique about your state, the likelihood that that will get addressed is diminished if it's a federally facilitated exchange, because they just can't do customization."

She added, "It kind of depends on how comfortable you are with HHS having that big a role in your insurance market. I think it really comes down to if you can find solace in that or not." That drew a murmur from the crowd at the Health Care Task Force meeting, which has now swelled to about 75, and includes many lobbyists and representatives of various parts of the health care industry.

Wilson told the task force, "The (Medicaid) expansion is a tougher issue. Your providers are very concerned about states not doing the expansion because of the uncompensated care. ... So there's a lot of concern by different constituencies in your state, and I think each state's going to have to take a really hard look at how the numbers look, and you're going to see a lot of variation in how states respond."