Some states are having a tough time coming to terms with the health care reform law that was enacted in 2010 and that will pick up steam this year. They are uniformly Republican states and they are not only resisting the law for political reasons, but are at the same time – and contrary to conservative orthodoxy – ceding authority to Washington. It makes no sense.

But four Republican states recently did what others are not doing: They set up insurance exchanges to benefit their residents who buy health insurance on the open market. The Obama administration last week conditionally approved exchanges organized in Idaho, Nevada, New Mexico and Utah. Mississippi may yet have an exchange approved, depending on the outcome of a dispute between the state’s Republican governor, who does not want to set up an exchange, and its Republican insurance commissioner, who does.

These were wise moves and, it must be said, wiser than the one that came out of the New York State Legislature, whose Senate Republicans also refused to act. What saved the state was the decision by Gov. Andrew M. Cuomo to do the job administratively.

Insurance exchanges are meant to offer a range of health insurance plans in the way that websites like Travelocity and Expedia provide travel choices. They are clearinghouses of competing insurance options for Americans who buy their health insurance directly.

So far, 17 states have received preliminary approval for their exchanges, including California, which has more uninsured residents than any other state. But some states are sitting down in the mud and refusing to act. They include Texas, Florida, South Carolina, Georgia and Alabama.

These states – champions of states rights and smaller government – have by default allowed the federal government to set up their exchanges for them. Not only does this fly in the face of conservatism, but of what was originally a Republican idea. Insurance exchanges were the conservative substitute for the “public option” that would have seen the government, itself, competing against private insurers to keep prices down.

Such are Republican politics in the 21st century: President Obama adopted a Republican idea, which causes Republicans to reject it.