“A cancer patient receives treatment at the Hospital of the University of Pennsylvania in Philadelphia. Pennsylvania is among at least six states that are creating their own health insurance marketplaces or considering it.” Matt Rourke/The Associated Press

“The launch of President Barack Obama’s Affordable Care Act was marred by the performance of the newly created state health insurance marketplaces.

“With generous federal financial support, many states created these markets, also called exchanges, based on soaring promises: Individuals and small businesses could compare policies. They could get federal subsidies. It would be easy to sign up. And if people’s income declined, they could enroll in their state’s Medicaid plan.

“It didn’t work out that way. Websites didn’t work. Data couldn’t be accessed. Call centers were overwhelmed, and states spent millions on quick fixes, many of which failed.

“Hawaii, Nevada and Oregon abandoned plans to operate their independent marketplaces and instead relied on the federal marketplace, Healthcare.gov. Other states, including California, Colorado, Massachusetts, Maryland and Washington, spent millions of dollars to overcome problems with technology.

“The experience so rattled states that seven years later, only 11 of them, plus Washington, D.C., operate independent marketplaces. The rest either use the federal marketplace or a federal-state partnership.

“But now at least six states — Maine, New Mexico, New Jersey, Nevada, Oregon and Pennsylvania — are creating their own marketplaces or seriously considering doing so.”