The Obama administration’s plan to implement insurance exchanges in time for Jan. 1, 2014, enrollment has met substantial state government opposition, raised more questions than answers and flashed warning signs of trouble ahead. A clear majority of states — 34 — still are not fully on board with running their own healthcare exchanges to comply with the dictates of the Affordable Care Act (ACA). Most of those states — as many as 26 — would rather leave the daunting implementation process entirely in the hands of federal officials. Just last week, Utah finally gave up on getting authorization for its proposed state-based exchange for individuals.
Many state governors remain reluctant, if not fully opposed, to enlisting as sorcerer’s apprentices in magically building the key regulatory architecture for ObamaCare. It might simply be good short-term politics for red-state Republican officials to avoid the blame for ongoing complications and contradictions that were made in Washington, but opposition to ACA-style exchanges should also reinforce a more principled strategy: to reshape the future nature of our healthcare system by supporting a better model of true choice and competition for willing buyers and sellers of diverse health insurance products.