Ready, or Not, for Obamacare

The day after the U.S. Supreme Court upheld President Barack Obama’s health-care reform law, his campaign put Martin O’Malley on the phone with reporters. A Democrat from one of the country’s bluest states, he referred to his Republican peers who’d waged the unsuccessful legal battle to strike down the Affordable Care Act as “laggards.” Now that the Supreme Court had ruled, he offered to help other states prepare for it, as he’d already been doing for more than a year. “We are ready and willing and very happy to share what we’ve learned in this process with governors of both parties,” O’Malley said.

The remark wasn’t as gratuitous as it sounds. The Affordable Care Act requires states to have the most important parts of the law up and running by Jan. 1, 2014. Many are unlikely to make the deadline. As of late July, only 18 states had even started putting in place the law’s central component: health benefit exchanges, the menu of insurance plans that currently uninsured Americans will choose from. Twenty-five states were either studying options or had yet to take significant steps. The Republican governors of six states—including Texas, Florida, and South Carolina—are simply refusing to create the exchanges, in hopes that if Mitt Romney is elected president he’ll repeal or at least delay them. If states don’t create exchanges, the law requires the federal government to step in and do it for them.