In a July 30 editorial opposing the implementation of the Affordable Care Act, the Wall Street Journal opined that planning for the new health insurance marketplaces called Exchanges belongs on a "fiasco list." However, the editorial misrepresented the pace of exchange planning, downplayed the catalyst of Republican "civil disobedience" in implementation slow-downs, and obscured the role that right-wing media and advocates have in this intransigence.
States That Have Attempted Exchange Implementation Are Actually "Well Underway"
Many of the nation's leading health policy organizations are closely monitoring implementation of health care reform and exchange progress is one of their metrics. The National Academy for State Health Policy (NASHP) is one such example, and the WSJ editorial cited them for the proposition that "by and large the states aren't" building exchanges. However, the editorial did not mention NASHP's most recent report on exchange implementation that instead notes in the opening paragraph that "many states are well underway in planning for and establishing their exchanges." Rather, without indicating the source, the WSJ used NASHP's "State Refor(u)m" project that is a user-generated "online network." That is, the metrics that the WSJ cited for the alleged "fiasco" of exchange implementation is a measurement of documents voluntarily uploaded to a wiki. State Refor(u)m does not claim to be a comprehensive progress measurement, but rather a clearinghouse reliant on user submissions.
Thus, the editorial's listing of "liberal leader" states who score low on this "milestone" measure of State Refor(u)m does not support its thesis. These "milestones" are not an accurate barometer of the difficulties in exchange planning - or even of completion of these actual metrics - but rather of the success of this network at attracting policy documents. Indeed, several of the states that the WSJ specifically lists as laggards - Massachusetts, California, Oregon, West Virginia, Colorado, Washington, Vermont, New York - actually have fully established exchanges, the first two of which were established by Governors Mitt Romney and Arnold Schwarzenegger, respectively.