A doctor and an American flag symbolizes U.S. health care
A doctor and an American flag symbolizes U.S. health care - 
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Kai Ryssdal:We are just now, believe it or not, getting down to brass tacks on health care reform. That year or so of debate we had was about the politics of it. Now Washington's writing the actual rules for how health care reform's is going to happen.

In that vein, President Obama had a session with state governors today. They're in Washington for their annual meeting. And they were a relatively hostile audience -- about half of the states are challenging health care reforms in court. So today the president said he can be flexible.

Our Washington bureau chief John Dimsdale reports.

John Dimsdale: The health reform law lets states come up with their own ways to expand affordable insurance coverage, but not until 2017. Before then, all states have to stick with the federal guidelines. Today, President Obama endorsed a Senate bill to let states design their own reforms three years earlier.

Barack Obama: If your state can create a plan that covers as many people as affordably and comprehensively as the Affordable Care Act does -- without increasing the deficit -- you can implement that plan. And we'll work with you to do it.

For instance, White House officials point to an idea from the governor of Indiana. He's considering using the new reform law's private insurance exchanges to cover Medicaid recipients.

Les Funtleyder is health care portfolio manager for Miller Tabak. He says states will want to tailor their health care systems, depending on how old, or rural, or educated the population is.

Les Funtleyder: The one-size-fits-all approach was never going to work in the first place.

But could White House flexibility allow states hostile to reforms chip away at them? The co-sponsor of the Senate bill, Louisiana Democrat Mary Landrieu, says that won't happen.

Mary Landrieu: The states have to reach the same goals. For instance, coverage must be provided for every adult. If some states think they can meet these goals in a different, more cost-effective way, that's what we all need to be talking about.

White House officials say they don't want to open the health reform law to any other changes.

In Washington, I'm John Dimsdale for Marketplace.