How Well Are Obamacare's State-Run Exchanges Actually Working?

As problems with Obamacare’s federal exchange system have continued, supporters of the health law have turned to a backup argument. Sure, the law is struggling due to technical problems, but in the states that decided to set up their own exchanges, it’s actually going reasonably well. California, in particular, is being singled out for its high enrollment numbers—numbers that some reports have said put the state on track to hit its enrollment targets.

The reality of the state-run exchanges is a little more complicated. There’s no question that the state systems are, on the whole, working better than the federally facilitated exchanges. But serious problems continue to plague a significant minority of the state-run exchanges. And even states said to be success stories may not be quite as successful as claimed.

The argument that state-run exchanges, put in place by state governments that wanted to make the law work, predates the October launch. Obama himself made a version of the argument during the last week in September, when he went to Maryland to give a speech about the law, and to tout its state-run exchange.

But Maryland is one of the states that has struggled most to get its exchange up and running. The technical troubles are significant enough that it turned to paper applications and other workarounds. But it’s not getting the sign up numbers it was hoping for. As The Washington Post reports, just 1,278 people signed up for private coverage in the state during October, and another 465 in the first week of November. Those low numbers, the Post piece notes, “raise questions about whether Maryland will achieve its enrollment target of 150,000 by the end of March.”