President Obama's plan to overhaul the nation's health care system hit another snag when Georgia's insurance commissioner said he will keep the state out of the new program to offer federally subsidized health insurance to people with health problems who cannot get insurance on their own.

In a letter obtained by the Associated Press on Monday, Republican John Oxendine said Georgia should not take part in the creation of an insurance pool, backed by $5 billion in federal money, designed to fund insurance for high-risk people who have been uninsured for at least six months. Oxendine said that although the program initially will be completely funded with federal money, he fears that the state eventually will have to foot the bill, putting a burden on Georgia taxpayers.

The Department of Health and Human Services (HHS) gave the states an April 30 deadline to say whether they would participate. Georgia is believed to be the first state to refuse to join the program. HHS is planning a federal backup program to serve residents of states that don't participate.