Gov. Robert Bentley and state lawmakers delayed two major decisions on health insurance this year, and now find themselves in hurry-up mode on one.

Bentley has until Friday to submit a letter to the Department of Health and Human Services on what Alabama intends to do in relation to the exchange, a marketplace for those without insurance to price plans and apply for subsidies to help pay for insurance. The exchanges are mandated under the Affordable Care Act.

The governors office acknowledged Friday that Bentley is speaking with other state governors about how to move, but said little else.

Our position remains that we will let the federal government know our intentions by the Nov. 16 deadline set by the Department of Health and Human Services, said Jeremy King, a spokesman for Bentley.

The governor also has not made a decision on whether to opt into an expansion of Medicaid that will be fully paid by the federal government through 2017, and about 90 percent covered by Washington after 2020. Some lawmakers have expressed concerns that the state will not be able to afford even a slight increase in Medicaid spending, with the General Fund budget still facing tight straits.

King said the governors office had serious concerns about the long-term costs, but did not rule it out.

Over time, the increased costs to states could be dramatic, he said. We are carefully evaluating the issues and will make fully-informed decisions based on what is best for Alabama.

Others argue that the improvements to public health and long-term savings from expanding insurance in the state are too valuable to pass up.

At the maximum, a few years out, the state will bear only 10 percent of cost, said Jim Carnes, a spokesman for Alabama Arise, which works on poverty issues in the state. Its just a dime on a dollar ... but you have to look at costs that will be offsetting.

Whatever paths the state chooses, the decisions will have ramifications for years.

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Alabama in health care quandary