Over the past few weeks, the Affordable Care Act’s implementation of a federal health exchange – the website set up for states that refused to establish their own health exchanges for citizens to choose health plans and sign up for coverage – has run into a series of problems. Outrage is expressed in some quarters that it is so hard for North Carolinians to peruse a selection of health plans, see what subsidies are available to bring prices down to reasonable levels, and buy coverage. However, a year ago this possibility wasn’t a mystery from either side of the political aisle in North Carolina.
Back then Representative Nelson Dollar, (R) Wake, said  “Clearly, the best thing for our state is to have a state-directed exchange as opposed to leaving it to the federal government and getting a cookie-cutter, one-size-fits-all program.” And NC Insurance Commissioner Wayne Goodwin (D) noted  as he argued why a state exchange was better than the federal one, “So basically the consumer, when they could have easily, quickly do what they do now, which is contact us … will be calling 1-800-WASHINGTONDC (to talk to) someone that doesn’t know North Carolina, doesn’t know our people, doesn’t have accountability to respond quickly.”
Turns out this criticism of NC Governor McCrory and the NC General Assembly’s eventual action rejecting  not only Medicaid expansion in NC but also a state health exchange is having exactly the consequences that these bipartisan commenters foresaw. In states that did take the steps to establish their own health care exchanges, people are enrolling in health coverage by the thousands and the state exchange websites are generally working well.
In California  just in the first week of operation, 29,000 Californians have already applied for coverage with an additional 27,000 applications pending. In small Connecticut  the exchange has already processed almost 2,000 applications. In Kentucky , there are over 45,000 completed applications and over 15,000 people enrolled in new insurance plans. And in Washington State  nearly 25,000 residents have enrolled in health coverage and an additional 37,000 residents have completed online applications.
So, in states that set up their own health exchanges residents are signing up by the thousands in just the first few weeks. NC had the chance to join this success story, was on track to establish its own exchange, and was derailed by unreasoning anti-Obamacare fever. No doubt the NC politicians who rejected not only a state health exchange and Medicaid coverage for our poorest citizens but also $74 million in grant money to upgrade computers, run, and advertise a state health exchange will be complaining the loudest about the Affordable Care Act’s current federal website problems. They hope they can deflect people from their own major share of the blame and how North Carolina could have avoided the current hiccups in the launch of the ACA.
Finally, the irony of some of the most stridently conservative voices in our state – like the Pope Civitas Institute – now complaining  about the problems with the federal exchange website when they were one of the loudest voices against  a state exchange over the last few years should be lost on no one.
It’s time for the Governor and legislators to reverse their poor decision and establish a state-run health exchange for North Carolinians.