“A major criticism of the Affordable Care Act (ACA) is its attempt to impose “one size fits all” health policy on states with
different populations and markets. Whereas health insurance was historically regulated by the states, the ACA and
accompanying regulation imposes numerous new rules onto health insurers and employer-provided plans. Millions of
Americans will be eligible for subsidized health insurance coverage in 2014, and supposedly able to enroll in said
coverage by October.”

“Thus, as it now stands, only 14 to 16 states (plus the District of Columbia) are likely to actually be operating state-run exchanges come October, when open season begins. There may be another two or three states with so-called partnership exchanges, but the feds will be responsible for most of the major functions in those states. Indeed, the final count could be lower as some states trying to set up their own exchanges—faced with significant technical challenges and limited remaining time—give up and default to a federally run exchange.”

“Having failed to persuade 26 states that participating in ObamaCare is a good deal, the liberals behind the law are denouncing these dissident Governors as federalist hypocrites. A few critics on the right are chiming in and arguing that the 26 are inviting worse results once the feds swoop in. So someone ought to say a word on behalf of the people who run state governments in the real world and have examined the health insurance ‘exchange’ question in detail. They’ve seen enough to know that the choice to set up and run these insurance bureaucracies is not a choice at all.”

“The federal government will likely be involved in running the ObamaCare exchange in at least 30 states, 26 of which expressly declined to establish state exchanges. One health-policy expert refers to it as an ‘administrative nightmare’ for the Department of Health and Human Services. Friday was the deadline for a state to let HHS know if it planned to establish a state exchange. Thus far only 18 states and the District of Columbia are planning on doing so.”

“Pennsylvania will not set up its own health care exchange under the federal Affordable Care Act, at least not for now, Gov. Tom Corbett said Wednesday, putting the state on a course to join others led by Republicans that will let President Barack Obama’s administration run its exchange. Setting up a state-based exchange would be irresponsible, Corbett said, as he faulted federal authorities for what he called inadequate answers to his questions about cost and other issues.”

“Now that the election is out of the way, the Obama administration is able to reveal more about its regulatory plans for implementing that law. On Friday, the Department of Health and Human Services released 373 pages of new Obamacare regs, and buried deep within is a 3.5 percent ‘user fee’ — that is, tax — on premiums from health plans sold on Obamacare’s soon-to-be-established federal exchanges. This tax comes above and beyond Obamacare’s $100 billion excise tax on insurers.”

“New Jersey Gov. Chris Christie (R) declined to set up a state-based insurance exchange under the healthcare law Thursday — the same day he met with President Obama on Hurricane Sandy aid. The move will be welcomed by conservatives who blamed Christie for praising Obama’s response to the storm. Sandy hit just before the election and distracted national media coverage from Obama’s campaign against Mitt Romney. “

“But the real story is that Democrats are reaping the GOP buy-in they earned. Liberals wanted government to re-engineer the entire health-care system and rammed the Affordable Care Act through on a party-line vote, not stopping to wonder whether it would work. Now that implementation is proving to be harder than advertised, they’re blaming the states for not making their jobs easier.”

“Arizona Governor Jan Brewer said on Wednesday she was rejecting a major provision of President Barack Obama’s healthcare reform law that calls for creating state-based health insurance markets where consumers can purchase private, federally subsidized coverage.”

“Delaying implementation until 2014 helped the president win re-election, but now the bill is coming due. The administration can’t forestall Obamacare’s massive regulatory impact any longer, and the result will keep Congress and the media occupied for months and years to come.”