Butch Otter has a new deadline — Dec. 14 — but the basic decision confronting the governor is unchanged.

Otter can decide that Idaho will construct its own health insurance exchange — an online marketplace where upwards of 300,000 uninsured Idahoans could shop for coverage.

Or Otter can decide to dig his boot heels into the ground and refuse to create an exchange, siding with the the ideologues in Otter’s own party who abhor “Obamacare” in all forms. This would be, at best, a symbolic gesture, since the federal health care law authorizes Uncle Sam to establish an exchange if a state says no.

A simple choice, really. Last week, the day of decision was fast approaching. But late Thursday, Health and Human Services Secretary Kathleen Sebelius gave the states a four-week extension, responding to requests from the Republican Governors Association and others.

We’re not sure exactly when due diligence ends and when procrastination kicks in. The idea of a state-run health exchange was discussed, at length, by a task force Otter appointed in July. In late October, this group recommended a state-run, nonprofit exchange on a 10-2 vote, submitting a 51-page report for Otter’s review.

What does Otter do with this recommendation?

Does Otter heed the advice of the majority of his task force — including legislators and representatives from the business and health care sectors? Or does Otter give oversized influence to the diehard naysayer in the group, Wayne Hoffman of the Idaho Freedom Foundation, a conservative lobbying group?

As long as we’re asking questions, is Otter looking forward — or looking backward?

Idaho and other states tried to convince the Supreme Court to overturn “Obamacare.” Republicans rallied behind a nominee, Mitt Romney, who vowed to repeal the law. Both efforts failed. So does Otter now govern from the perspective of someone who realizes that this law isn’t going away?

If Otter accepts this fact as political reality, unpleasant as that might be for him to stomach, then his choices on a health exchange are straightforward. If “Obamacare” is here to stay, then a health exchange is on its way. The only question is whether Idaho opts to craft its own exchange, locally operated and responsive to the local market, or accepts whatever the federal government comes up with.

It’s a question of local control. As long as Otter has the initiative and the good sense to assume control.

Uncle Sam gave Otter and fellow governors more time to deliberate.

The path forward, however, remains as clear as ever.

“Our View” is the editorial position of the Idaho Statesman. It is an unsigned opinion expressing the consensus of the Statesman’s editorial board.