Now that President Barack Obama has won a second term, there is no question the Affordable Care Law will move forward in states across the country.
Gov. Scott Walker said he would not begin planning to implement the law until after the election.
Now he has eight days to make some important decisions on the future of Wisconsin health care coverage.
"It's basically filling out a form and saying this is the type of exchange we're going to have but you're not going to put a lot of meat on the bones at that point in time," said Michael Richards with Gundersen Lutheran.
Walker must decide whether Wisconsin will run its own health insurance exchange for individuals and small businesses, leave it up to the federal government, or use a combination of both.
To understand the exchange you can think of it kind of like an online marketplace where individuals and small businesses shop for insurance coverage.
While some think choosing a state-run exchange is an easy choice, it may not be that simple.
"There's a lot of opportunity here in Wisconsin to develop a creative exchange that addresses unique needs. We have a lot of folks that have thought about this issue, that have worked on the issue that have ideas to put on the table, and to let this just be developed by federal policy makers I think is a mistake," said Bobby Peterson executive director of ABC for Health Inc.
Walker was in La Crosse for a small-business summit on Thursday and when asked about the decision, he said it all depends on how much control Wisconsin would actually have of the exchange.
"There's a part of me that looks at the state-run one and says I don't want to give up anything that I don't have to to the federal government. Having said that, there's a real question as to any state, not just Wisconsin, with the way the law's set, does the state have any real flexibility in how to do that, and increasingly our belief is it doesn't. If the state runs it, eventually money goes away from the federal government and you may expose state taxpayers to picking up more and more of that cost. Whereas if it's a federally run exchange, they take up more and more of that cost," said Walker.
As the deadline draws near, Walker said the decision will hinge on what option sets Wisconsin up for success.
"The question is which is the best way to implement an exchange in the state that ultimately does the most to protect the taxpayers in the state," said Walker.
After a response is turned into the federal government next week, it will be reviewed this January, but it won't be until January 2014 that the exchange will actually take effect.
Walker said that leaves them with a full year to design Wisconsin's exchange or change their mind on whether it should be run by the state, the federal government, or by a partnership.