Editorial: ObamaCare resisters, get with the program

• The Affordable Care Act is on track to take full effect starting in 2014.
• Six governors are refusing to go along with the law's expansion of Medicaid coverage.
• Also, 15 governors have refused to set up state exchanges, and at least 13 more are still deciding.

From the moment President Obama signed health reform into law in 2010, opponents were sure it wouldn't last. Congress would repeal it, or the Supreme Court would declare it unconstitutional, or a Republican president would kill it.

To quote Texas Gov. Rick Perry, a leading foe of ObamaCare: Oops.

With Obama's re-election, the Affordable Care Act has survived everything its opponents threw at it and is on track to take full effect starting in 2014. And that's a good thing: It means the USA can finally join the rest of the world's industrial democracies in guaranteeing that most of its citizens have health coverage.

But some politicians, like Japanese soldiers who hid in the jungle for years after the end of World War II, are determined to battle on. In Wisconsin, for example, nine state legislators are trying to pass legislation to allow state authorities to arrest any federal official who tries to implement ObamaCare.

These dead-enders would be doing their constituents a favor if they spent their energy and political skills not on a quixotic battle to overturn the law, but on making it work. And, because ObamaCare is far from perfect, the critics would also do well to focus their energy on improving it.

Instead, at least six governors are refusing to go along with the law's expansion of Medicaid coverage for some of their poorest citizens, even with the federal government picking up the entire cost for the first two years, and 90% or more after that.

The latest battle is over one of the least costly and most consumer-friendly features of ObamaCare: the state health exchanges where individuals and small businesses will be able to compare and buy insurance plans, the way travelers buy airline tickets at online sites and Medicare recipients choose drug coverage.

So far, 16 states and the District of Columbia have agreed to run their own exchanges. But egged on by the conservative group FreedomWorks, which argues it's still possible to kill ObamaCare by blocking it in the states, several Republican governors have dug in their heels. So far, 15 governors have refused to set up state exchanges, and at least 13 more are still deciding.

The deadline was supposed to be Friday, but the Obama administration has given states an extension to Dec. 14. If a state refuses to set up an exchange, the federal government will do it instead, or states can partner with the feds to run a hybrid exchange, with Washington doing a lot of the heavy lifting.

Opposition to health exchanges seems pointless. The two states that already operate exchanges — conservative Utah and liberal Massachusetts — are bringing helpful information and order to a market that can otherwise be confusing and inefficient.

Some of the refuseniks have said running an exchange puts too much of a financial burden on their states. Really? The law provides grants to pay to run a state exchange for the first year; after that, states could cover the cost by charging insurers a fee to participate.

Other governors complain that federal regulations would make state exchanges a straight jacket. Yes, the law imposes common-sense restrictions such as a ban on selling insurance that's useless if a beneficiary gets sick. But states have flexibility to tailor their exchanges.

Funny thing is, Perry and many of the other governors opting to let the federal government run their health exchanges are usually the first to insist that states do things like this better than Washington.

Of course, if more states were like Massachusetts, where just 5% of residents have no health insurance, and fewer were like Texas, where a nation-high 27% are uninsured, ObamaCare might not have been necessary in the first place.

DEFAULTING TO WASHINGTON

Fifteen states have decided not to set up their own health care exchanges:

Alabama

Alaska

Georgia

Kansas

Louisiana

Maine

Missouri

Nebraska

New Hampshire

North Dakota

South Carolina

South Dakota

Texas

Wisconsin

Wyoming

Source Kaiser Family Foundation statehealthfacts.org