WASHINGTON – Three years, two elections, and one Supreme Court decision after President Barack Obama signed the Affordable Care Act, its promise of health care for the uninsured may be delayed or undercut in much of the country because of entrenched opposition from many Republican state leaders.

In half the states, mainly led by Democrats, officials are racing deadlines to connect uninsured residents to coverage now only months away. In others it’s as if “Obamacare” – signed March 23, 2010 – had never passed.

Make no mistake, the federal government will step in and create new insurance markets in the 26 mostly red states declining to run their own. Just like the state-run markets in mostly Democratic-led states, the feds will start signing up customers Oct. 1 for coverage effective Jan. 1. But they need a broad cross-section of people, or else the pool will be stuck with what the government calls the “sick and worried” – the costliest patients.