That’s because the law still faces huge legal and logistical hurdles. Tops on the list are challenges to the law’s insurance exchanges, starting with a lawsuit filed by Oklahoma’s attorney general. That case, which revolves around legal problems examined in a paper by Case Western Reserve law professor Jonathan Adler and Cato Institute Health Policy Direct Michael Cannon, may decide whether employers in states that do not set up their own health insurance exchanges can be taxed under the law, as well as whether it is legal for the federal government to offer insurance subsidies through exchanges it runs in states that opt out. The law, which taxes employers that don’t offer insurance in order to fund those subsidies, states that subsidies are only available in state-run exchanges.

If Oklahoma’s suit prevails, states will have a large incentive to opt out of creating exchanges in order to protect employers from the tax penalty. And the federal exchanges will be largely useless. “No one would go to those exchanges. The whole structure created by the health care reform law starts to fall apart,” Gretchen Young, senior vice president-health policy at the ERISA Industry Committee told Business Insurance.