Republican states are now refusing to run exchanges or, like Utah, stalling and lobbying for leeway to pursue homegrown reforms.
Whether the political "saber rattling" poses a real threat is hard to say, said Cartwright. But it's misguided and inhumane to be gunning for a fight "under the guise of ... declaring independence from the big, bad feds" when Utahns' lives and livelihoods are at stake, she said.
Utah already has an exchange, known as Avenue H, an online shop where small-business employees can buy health insurance using contributions from their employer.
Gov. Gary Herbert asked Obama earlier this week to declare the 4-year-old shopping portal good enough to meet the Affordable Care Act's standards, even though it is missing key features, such as controls on prices and the ability to enroll residents in Medicaid.
The White House hasn't responded publicly, but is negotiating privately with Herbert, according to Avenue H director Patty Conner.
Precisely what Utah has in store for its exchange isn't known. States have until Friday to decide whether to create their own federal exchange, partner with the feds to run one, or default to having the feds operate one for them.
Conner declined to speculate how or when the White House will rule on Herbert's proposal. She said by the close of business Friday, the governor is expected to release a more detailed blueprint of his plan.
But even conservative health policy experts have been skeptical of Avenue H and its potential as a market-based alternative to federal health reform.
There's no mandate to have insurance in Utah, or tax breaks to make it affordable enticements under the federal law that Herbert dislikes, and that some argue are critical to success of exchanges.
To avoid drawing a disproportionate number of older, sick people, causing prices to spike, states have to entice young, healthy people to the exchange pool, said Judi Hilman, executive director of the Utah Health Policy Project.
That's how it works in Massachusetts, the model for the federal version. Taken to a national scale, it could solve a problem known as "job lock" where unhappy workers are loathe to leave their jobs for fear of losing their health benefits.
That's exactly what happened to Cartwright, who worked in TV journalism and marketing before striking out on her own in 1996.
Her business thrived. She had no trouble affording health insurance, but couldn't find a carrier willing to cover her due to chronic health problems from her childhood.
"My health has never been good," she said, declining to elaborate for fear of losing business.
Right now in America, employers that offer health insurance must cover all eligible full-time employees. But the self-employed, part-time workers and the unemployed enjoy no such guarantee.
"One agent told me that it was highly unlikely that I, as a single business owner, would get insurance," said Cartwright. "His comment was, 'No one is getting approved these days. If you'd even had so much as a broken finger in your lifetime, you wouldn't get insurance.' "
For a while, Cartwright was able to join her husband's plan. He's now deceased, and her only recourse has been Utah's insurer of last resort, its high-risk pool.
The program is quite expensive. Still, Cartwright said she's "very, very grateful" for it.
But the program will likely dissolve in 2014, when access to insurance will be guaranteed for everyone through exchanges.
If Utah succeeds at blocking a federal exchange, where will hard-working, middle-class professionals "like me" turn? Cartwright asks. "What state should I move to, take my ideas and take my business to? Or do I shutter it and take the first job I can find, just for the benefits?"
She hopes it doesn't come to that and that federal exchanges will "bring on a golden age of the entrepreneur."
"Longtime, loyal, overworked employees just might leave their jobs to pursue a dream of their own business," freeing up jobs and boosting productivity, she said. "And it might make employers more cognizant of the potential brain drain, thus more willing to make work conditions better … conditions which have deteriorated rapidly during the recession."
On Friday, Gov. Gary Herbert is expected to release a more detailed blueprint of his plan for an exchange in Utah.