The state should not go to the trouble and expense of establishing health insurance exchanges that may or may not last if the Patient Protection and Affordable Care Act (PPACA) were to be significantly altered or entirely repealed. The better course, if such exchanges must be established, is to let the federal government establish them while the state waits to see whether the PPACA will survive as it is currently constituted. The state should also not participate in the massive and costly expansion of the Medicaid program, as contemplated under the PPACA. Although the federal government would bear most of the costs during the startup phases of the expansion, the costs would ultimately fall to the state. Moreover, as in other states, the Medicaid program already is devouring an inordinate share of the state’s revenue.