Obamacare might fail or cost a hell of a lot more money.
The states, Levin and Capretta remind us, have two key choices to make that together will put them in the driver’s seat: whether to create state health-insurance exchanges and whether to expand Medicaid. As to the first choice, running the exchanges would be an administrative nightmare. It would require a complicated set of rules, mandates, databases, and interfaces to establish eligibility, funnel subsidies, and facilitate purchases. Moreover, this would have to be accomplished in the context of what Levin and Capretta describe as “broad and often incoherent statutory requirements and federal regulations that have yet to be written.”