Leavitt is a big proponent of the early implementation of Obamacare exchanges, the state-level apparatus at the core of Obamacare. Most conservatives oppose implementation, on both principle and practical grounds. They want the federal government to implement any exchanges. States who do implement will have to raise taxes to cover their share of the exchanges.
Because of a quirk in the law, federal subsidies for health insurance in the exchanges will only kick in if a state implements its exchange. The fewer states who implement their own, the more likely the law will have to be changed, opening it up to large-scale changes of the kind conservatives want.