A unified national health exchange in which all Americans could buy insurance was one of the possibilities most reviled by opponents of the Affordable Care Act (ACA), now more often called Obamacare. So it is richly ironic and surprisingly helpful that states led by Republicans are largely defaulting to just such a unified system.

These exchanges will allow individuals and small businesses to shop for privately run insurance policies that make the most sense for them. The main existing example is in Massachusetts. An official there describes it: “We’re a little bit like Travelocity for health insurance. It’s an electronic, automated store for insurance.” There it typically takes people 20 to 30 minutes to evaluate their options, decide which plan to purchase, push a button and they’re enrolled, according to the Washington Post.

New federal and state-run systems will offer similar choices, matching coverage options with willingness to pay.

Oregon, Washington and all our near neighbors in the West are setting up our own health exchanges. This means greater flexibility and local control of this pivotal new system that will transform the lives of the currently uninsured, starting next year. Gov. John Kitzhaber’s leadership on Oregon’s health care initiatives won him a seat in the first lady’s box at the State of the Union speech.

Seventeen states and the District of Columbia signed up to run exchanges before the Feb. 15 deadline. Several others will partner with the federal government. But the feds will themselves run 26 of the state health exchanges.

This certainly is in part because of a political-legal miscalculation. A large block of states from Montana to Florida incorrectly assumed a conservative Supreme Court would toss out the ACA or that President Romney would move to repeal it. Reality moved in other directions.

In other cases, the reasoning was “on their heads be it” if Congress and the president want universal health care, let them also deal with the hassle and expense. ACA supporters in some of the dissenting states say they prefer federal management to a homegrown system that might be designed to fail.

The politics of all this will fade to insignificance soon as far fewer people are forced to defer vital health decisions because they lack insurance. Already, a rule was finalized last week that eliminates long-standing discrimination against mental health coverage in insurance policies. (As an aside, we should point out that if there’s but one small area of agreement between opposing camps in the nation’s still-raging debate over gun control, it’s that our society can no longer afford to continue short-changing mental health care.) Additional fair, humane reforms are in the pipeline.

For low-income residents, expansion of Medicaid coverage alone will offer health care to an additional 325,000 people in Washington over the next few years, starting in January. Oregon still is only leaning toward Medicaid expansion, which would extend benefits to an additional 252,000 individuals. It should do so.

It is true that we must keep a close eye on the costs associated with all this. But nothing is more expensive to a nation than needlessly sacrificing our own citizens because of lack of routine modern medical care.

If paying for such care means we can no longer afford entanglement in optional foreign wars, so be it.

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