I think this story from Oregon is worth highlighting as we focus on all the problems with the federal exchanges. From Oregon Live:

Though Oregon’s health insurance exchange is not yet up and running, the number of uninsured is already dropping thanks to new fast-track enrollment for the Oregon Health Plan.

The low-income, Medicaid-funded program has already signed up 56,000 new people, cutting the state’s number of uninsured by 10 percent, according to Oregon Health Authority officials.

Though the new exchange called Cover Oregon was originally intended to be used for Oregon Health Plan enrollment, the online marketplace doesn’t work yet. Instead, new Oregon Health Plan members are being enrolled using a fast-track process that was approved by the federal government in August.

The state still can’t get their exchange to work on time but they have had no problem expanding Medicaid. That is because just giving people public health insurance is incredibly quick, easy and cheap. That is why the Medicaid expansion was by far the best part of the new law.

You could simply expand an existing public health plan or create a new one in a fraction of the time, and overall it would cost significantly less.

This whole insane Affordable Care Act design was about needlessly leaving in place private middlemen, and that created yet another layer of extremely expensive and complex bureaucracy.