Missouri -- Voters approved a ballot measure that prevents the governor or a state agency from setting up an exchange without legislative or voter approval.

Florida -- Florida voters rejected a proposal that would have banned government mandates for obtaining insurance such as required by the Affordable Care Act. The proposed state constitutional amendment required 60 percent approval but didn't even have a majority with most of the vote counted Tuesday. It was favored by 48 percent and opposed by 52 percent.

Alabama -- Voters chose to prohibit individuals and businesses from being compelled to participate in any health care system. The initiative is considered largely symbolic.

Wyoming -- The ballot initiative passed to amend the state constitution to declare that the citizens of Wyoming have the right to make their own health care decisions and allow the state to act to "preserve these rights from undue government influence." The vote is considered largely symbolic.

Vermont -- The state issued a formal RFP late last week for health plans and stand-alone dental plans to sell on the exchange, known as Vermont Health Connect. The exchange is looking to make the final plan selections by mid-July.

New Mexico -- The planning group is looking to piggyback an exchange on an existing state health insurance program launched almost 20 years ago. The Health Insurance Alliance was created in the state to expand voluntary insurance coverage for small employer groups and individuals, but currently covers just about 4,000 people. A legislative workgroup has been studying whether the HIA would satisfy exchange governance requirements.

Virginia and Kansas Opt to Not Run an Exchange -- Governor Bob McDonald of Virginia and Governor Sam Brownback of Kansas, both Republicans, announced that they would not pursue a State-based exchange. This means that the Federal Government would run the exchanges in those states