Some governors whose states aren't ready to run exchanges are considering the administration's fallback offer to run the new markets through a partnership.
"The real question for Republican governors is: 'Are you going to let the feds come into your state?'" Ramlet said. "The question for the Obama administration is whether they are going to have more flexibility."
Major regulations are due shortly covering such issues as exchange operations, benefits and protections for people with pre-existing health problems. That could signal the administration's willingness to compromise.
A check by The Associated Press found 17 states and the District of Columbia on track to setting up their own exchanges, while 10 have decided not to do so. The federal government could end up running the show in half or more of the states.
The states on track include California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New York, Oregon, Rhode Island, Utah, Vermont, Washington, and West Virginia.
Not setting up exchanges are Alaska, Florida, Louisiana, Maine, New Hampshire, South Carolina, South Dakota, Texas, Virginia, and Wisconsin. Missouri and others are likely to join the list.
A recent AP poll found that 63 percent of Americans want states to run the exchanges, with 32 percent favoring federal control.
GOP governors are also seeking flexibility on expanding Medicaid. They are pressing Sebelius on whether the administration will approve partial, less costly expansions, more attractive to cash-pressed states.
As far as Medicaid, 11 states and the District of Columbia have indicated they will expand their programs, while six have said they will not. That leaves more than 30 undecided.
The states definitely expanding Medicaid include California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, New York, Vermont, and Washington. Those declining include Florida, Georgia, Louisiana, Mississippi, South Carolina, and Texas.
On Capitol Hill, Republicans say if a budget deal is going to include tax increases, it must also come with cuts to the health care law, or money-saving delays in its implementation.
While major changes can't be ruled out, they don't seem very likely to former Senate Majority Leader Tom Daschle, D-S.D., who is close to the administration.
"I think Democrats are increasingly emboldened about the health care act," Daschle said. "The president won re-election partly by defending it. There is a new dynamic around the health care effort."
Republican attempts to amend the law will continue, he said, but outright repeal is no longer a possibility.
Speaker Boehner seemed to second that in an interview with ABC News. Asked if he will make another attempt to fully repeal Obama's law, he responded, "Well, I think the election changes that."
But he added that parts of the health care law are very expensive and difficult to carry out and "everything has to be on the table" in budget negotiations. Later, spokesman Kevin Smith said that Boehner is "still committed to full repeal."