The election results pose a dilemma for states like Wisconsin that put off implementing health reform exchanges. Republican Governor Walker opposes the signature initiative of a democratic president elected to his second term.

In a week and a half, the state faces a deadline. Officials are supposed to tell the federal government whether Wisconsin will create an online marketplace to buy health insurance. If not, the federal government will put in place its own exchange.  There's some indication Governor Walker's administration is at least considering its own exchange, even though it turned down 38 million dollars in federal money to implement it .

"Our open records request revealed that the insurance commissioner's office told the Secretary of Health services they could be ready by November 16th if they decide to go forward, says Citizen Action Wisconsin Director Robert Kraig.  "But we don't know what the plan is. There's been no public discussion of it."

That lack of public discussion worries health care advocates, like Kraig.  "It's our concern -- since this is such a very important decision-- that the Walker Administration will lean over backwards to help insurance industry over consumers and have  much less consumer friendly exchange ."

The exchanges are intended to offer affordable, comprehensive health plans to individuals and small businesses.  So far, 14 states have enacted legislation to start an exchange. A spokesman for Governor Walker says the administration will be meeting over the next several days to decide what it will do.