Virginia's misstep on health care reform

President Barack Obama's signature domestic achievement appears here to stay. That means the federal overhaul of health care insurance will proceed, despite Republicans' hopes to the contrary.

It also means that in 2014 Virginia likely will be served by a federal health insurance exchange, because Gov. Bob McDonnell spent months sitting on his hands rather than working to create a state-based marketplace.

The exchanges are a critical component of the Affordable Care Act's goal to make health insurance more affordable and more widely available.

Because reform commands insurers to sell to everyone and requires everyone to have insurance, the law mandates creation of exchanges where customers can choose among the options. Because the exchanges would include more people, goes the theory, insurance premiums would be cheaper than on the open market.

The law allows states to create their own marketplaces, from which customers can choose policies, or defer to the federal government to do it.

McDonnell has plenty of company among Republican governors who declined to create their own programs.

That is a strategic blunder, as much the product of wishful thinking as political calculation. It has led the commonwealth (and other states) to an outcome both avoidable and undesirable: Rather than having a health insurance exchange specifically for Virginians, citizens will be left to navigate a federal one.

It also means Virginia's leaders wasted a significant amount of time and energy over the past two years developing their own model.

McDonnell's post-election reversal - deciding that Virginia may be better served by a federal exchange after all - suggests lawmakers, industry experts and others spent countless hours discussing and drafting a framework in a futile but expedient exercise.

McDonnell appointed members to the Virginia Health Reform Initiative advisory council, and the federal government provided a $1 million grant to help fund the planning under the belief that Virginia intended to pursue a state-based exchange.

The resulting legislative proposals languished in the General Assembly at McDonnell's request, even though everyone knew that if the U.S. Supreme Court upheld the act, and Romney lost the presidential election, Virginia would have a hard time meeting the deadline to plan its own exchange.

The court upheld the act and Romney lost, and now GOP governors around the country are searching for some way - any way - to carry on the fight.

Support for a state-based system has been nearly universal, and for good reason: There is little sense in surrendering control to the federal government on a matter that the state is already in position to control; its Medicaid enrollment system has undergone a significant technical upgrade, and that same system, officials have said, is capable of being used for the health benefits exchange.

McDonnell and other members of the Republican Governor's Association asked the White House to give them more time, and late last week, they got it. They'll have until Dec. 15 to get the information they claim to lack, and to end the political maneuvering.

Nearly 20 states - including New York, Maryland and California - have already created the exchanges. Perhaps over the next few weeks, McDonnell could call one of them.

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