Most of the least healthiest states' governors opted to not pursue a state-level health exchange.
Of the 12 unhealthiest states in 2012, only one -Kentucky- opted to set up its own state health exchange under the Affordable Care Act. Arkansas and West Virginia chose to set up joint Federal-state exchanges. All three states had Democratic governors in 2012.
One other state in the bottom quarter of health rankings also had Democratic governor in 2012. Missouri voters in 2012, however, passed a law blocking their governor from setting up a state health exchange.
The other 8 unhealthiest states currently have Republican governors.
These maps underscore the political element involved in decisions to expand health insurance to the states with the most serious health challenges.