California has moved quickly to implement key provisions of the federal health care overhaul law, including a health benefits exchange, but the exchange – and California's plans – could be vulnerable as House Republicans threaten to starve the federal health program of funding.

Last month, California became the first state to begin establishing a state-run health insurance exchange that is supposed to open for business by 2014 to help millions of the state's uninsured obtain health insurance.

The U.S. Department of Health and Human Services has given the state $1 million – with possibly more funding to come, federal officials said – to help set up the exchange. But the prospect of additional federal funding could face intense scrutiny by congressional Republicans seeking to cinch up congressional purse strings.

Republican control of the House "could make things very messy. Actually, it's already very messy," said professor John Ellwood of the Goldman School of Public Policy at UC Berkeley, a former special assistant at the Congressional Budget Office.

"If something requires an appropriation" of federal funds, "that's where the Republicans will attempt to starve it," Ellwood said.

The federal government expects to spend nearly $1 trillion over the next 10 years to implement the health care package – much of it already appropriated when the legislation was signed into law by President Barack Obama in the spring.

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