Monday the state of Alabama said it will not participate in coming up with guidelines (there are 10 categories in the ACA (example: maternity, prescription drugs, hospitalization, etc) that could be offered in the healthcare exchanges.
In 2014, there must be a healthcare exchange in Alabama. A healthcare exchange is where people can shop and compare insurance plans. There is not currently a healthcare exchange in Alabama.
By 2014, the state can set up the exchange, or help with it (examples – help regulate, offer consumer assistance, oversee plans, etc) or the state could simply choose not to do anything and the Federal government will do it.
Think of today as a floor not a ceiling in this debate.