All of us face the choice of joining the future or ignoring it. In the private sector, ignoring the future can be fatal.

Those options are staring at 32 states that have not set up insurance exchanges under the Affordable Health Care Act.

With a February deadline looming, only 18 states have moved to set up insurance exchanges that are called for in the Health Care Act. Many states that failed to act have Republican governors. Under the new law, the federal government will set up insurance exchanges in those states. The GOP states’ passive-aggressive behavior is not playing well. The Washington Post on last month reported on the irony of Republican governors ceding local control to the federal government.

Robert Laszewski, an insurance industry consultant told the Post:

“If you believe in states’ rights and you believe in state control, why would you cede that control? ... There’s a lot of cut-off-your-nose-to-spite-your-face going on,”

New Jersey Gov. Chris Christie complained to the Post that it was hard to determine the costs of setting up an exchange.

Gov. Christie and the other recalcitrant GOP governors could call Oregon, which set up an insurance exchange in 2011. Debate in the Oregon Legislature centered on the urgency that if Oregon didn’t act, the feds would do it for us.

Oregon saw the future coming when it enacted the Oregon Health Plan, which went into effect in 1993. The funny thing is that the Oregon Health Plan is a very Republican idea, even though it was championed by a Democratic governor, John Kitzhaber. The basic premise is that we can’t pay for everything. Thus we must establish priorities for reimbursement.

The greatest irony of all is the giving states the opportunity to set up insurance exchanges was put into the Affordable Health Care Act as a concession to Republican lawmakers. Go figure.

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