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Democraticare starts 10 months from now

As The Wall Street Journal noted in an editorial, Democrats' signature legislation, The Affordable Care Act, is to take effect about 300 days from now.

Observers doubt that this vast regulatory creation will be ready on time. It's an enormous undertaking.

There are policies to write, regulations to issue, policies to effect, boards to form, computer systems to install, software to write, facilitators to train . . .

And blame to deflect if one's creature runs amok.

That's where it gets interesting.

The act that is to insure at least 30 million more Americans envisioned that states would set up "exchanges" to help people find subsidized coverage. The deadline for functioning was October, which was pushed to November, which was pushed to December.

Seventeen states have indicated they will run exchanges. Six have chosen a federal-state model, whatever that means.

But 16 states won't participate and 11 are undecided.

"That means [Health and Human Services] will probably be responsible for fallback federal exchanges in full or in part in as many as 25 or 30 states," the Journal said.

But HHS "has declined to reveal basic operational details except to make clear that state-based exchanges won't really be run by the states," the editorial said.

"No matter which option is chosen," as Scott Walker put it, "Wisconsin taxpayers will not have meaningful control over the health-care policies and services sold to Wisconsin residents."

Said the Journal: "So if things don't work, voters will blame the governors for decisions made in Washington."

Governors are coming under intense pressure from federal officials and insurance and provider lobbies to get busy setting up exchanges they won't control.

The Journal counsels caution.

Governors who let themselves get rolled "are setting themselves up as political fall guys . . . " it said.

Good advice.


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