Most states have lengthy contracting processes, in which they must request proposals and review multiple bids before signing up vendors. Those deals would need to be in place before any software building begins. The Obama administration had nearly four years to develop and build its enrollment system, HealthCare.gov, which barely functioned at the outset. Peter Lee, the executive director of the California marketplace, Covered California, which is considered one of the country’s most successful, said that his system was barely finished in time, and he had the ability to call up local technology C.E.O.s for advice. Andy Slavitt, who joined the Obama administration in 2014 to help rebuild the ailing HealthCare.gov, and is strongly opposed to the Republican bill, said it would be close to impossible for most states to build meaningful systems for providing health insurance on such a timeline. “This is a fantasy document developed without the benefit of talking to people who have actually had to operationalize these things before,” he said. Passage of the bill would set off a state rush for help from the limited group of contractors who have built big systems. Mike Leavitt, a Republican who was Secretary of Health and Human Services under George W. Bush, and a governor of Utah, now runs a consulting firm that helps states build and manage exchanges. He said he supported the general idea of giving states more power. He was optimistic that some states could adopt out-of-the-box systems within two years, but probably not all. “There are different levels of complexity involved in states, and there’s different levels of capacity, and there’s different levels of experience,” he said. Many experts I spoke with were confident that most states would find some way to get the federal money, given how big the stakes were. They were less sure about whether states would be able to use it in a way that would provide health coverage quickly to the people currently served by Obamacare. “The metaphor I think about is it’s saying, ‘We’re going to continue having a freeway full of fast-moving cars, but we’re going to remove the lane line and the speed limits and say we hope things work out,’ ” Mr. Lee said.
In 2010 , health care policy makers in Massachusetts argued that the state should build a system to expand coverage to its uninsured employees . It took several years before Romneycare was fully up and running .