“On the ever-lengthening fiasco list, the ‘exchange’ problem is one of the worst. Congress told states to build these bureaucracies that will dispense health insurance subsidies and regulate coverage, but by and large the states aren’t doing so. The National Academy for State Health Policy reports that only 13 states are making ‘active’ progress on their exchange. That means they’ve checked off five or six of the seven basic boxes that the Health and Human Services Department says they must, like pass legislation or issue an executive order establishing an exchange.”