They lost at the Supreme Court. And they lost at the ballot box. But opponents of Obamacare aren’t giving up yet. Since they don’t have the votes to repeal the law, they’re trying the next best thing: Crippling it.

Their focus, at the moment, is on the development of insurance “exchanges.” Exchanges are basically virtual marketplaces for people buying coverage on their own, because they don’t have access to affordable coverage from an employer. Think of the exchanges as the rough functional equivalent of Expedia or Travelocity, only instead of buying an airline ticket you’d go online to buy health insurance. You’d have full information on what the plans covered, and how much they would cost, so you could shop intelligently. And—this is the important part—you’d have access to these policies, at the prices listed, regardless of any pre-existing conditions. If you couldn’t afford to pay for the policies on your own, you’d be eligible for assistance from the federal government.

Obamacare calls upon the states to create their own exchanges, or to get together with neighbors and form “regional exchanges,” by January 1, 2014. Massachusetts already has one, called the “Connector,” and about a third of the states are on their way to creating versions of their own. It's a daunting challenge, administratively and logistically. But states like California and Maryland, where officials support the law and have extensive experience regulating health insurance, should be able to meet the deadline. Many other states will likely opt to participate in special partnerships with the federal government, so that they can get some assistance building and then running the exchanges—at least for the first few years.

But some states with conservative leaders and lawmakers are refusing to create exchanges. Obamacare anticipates this possibility: When state officials opt not to create their own exchanges, the federal government steps in and does the job for them. But Obamacare critics think they’ve found a way to undermine that effort, because of some ambiguity in the text of the law: It says very clearly that the federal government can set up exchanges in lieu of the states, but the language is a little fuzzy when it comes to whether the federal government can also offer subsidies through those exchanges.

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