Obamacare’s Left-Leaning Federalism

It’s now official that the federal government will run 26 state healthcare exchanges, mostly in red states:

Exchanges By State

Sahil Kapur analyzes the situation:

“Now, in an ironic way, some of what progressives wanted is going to happen. The national government will be setting the framework for at least half of the country,” Theda Skocpol, a professor at Harvard University and expert on health care politics and policy, said in an email Tuesday. “State-level experiments and variants will often have a more progressive flavor — in the states doing their own exchanges — and of course those may create models that could later spread. Meanwhile, the feds will at least create some consistency.”

The immediate political upshot for leaders of the Republican states that stonewalled the exchanges is that they’ll avoid the wrath of their conservative flanks. And in the long-run, this decision allows them to more easily blame the federal government if things go wrong.

Suderman wonders whether the exchanges will open on time:

[O]fficials at the Department of Health and Human Services, which is heading up the federal exchange efforts, are projecting confidence, promising the exchanges will be open for business this October as called for by the law. But the law’s track record so far does not inspire much faith. Last summer, the American Action Forum found that 47 percent of the law’s implementation deadlines had been missed.

(Map from Kaiser. Interactive version here.)