Let’s start with the disastrous launch of the behemoth federal insurance exchange run by the Health and Human Services Department. Yes, Republicans managed to divert attention from that to their own comedy of errors on Capitol Hill. But don’t forget why the federal exchange, healthcare.gov, is so gigantic. It’s because just 16 states and the District of Columbia created or plan to create their own marketplaces. By contrast, almost all of the nation’s 30 Republican governors took a pass on setting up exchanges for their own states, punting that task to the feds. That along with other tactics and decisions amounts to what you might call the GOP Effect—damage that’s indirect, often uncoordinated, and possibly at times unintentional, but potent all the same.

For instance, some of the initial problems on the federal exchange were due to heavy traffic. It would not have been as much of a bottleneck had more governors created individual state exchanges. More serious and continuing problems are due to misjudgments and shortcomings embedded in the federal website itself, and the worst may be yet to come…

The 16 states that built their own sites have used a variety of contractors and many of their marketplaces have launched more smoothly than the federal healthcare.gov. The bottom line is that the pressure on the federal exchange would have been far less and its design flaws would have affected many fewer people had, say, 20 more states set up their own exchanges using a variety of contractors and approaches.