Can a state make an insurance exchange work? While Utah is sometimes held up as an example of a market-friendly exchange, it’s not clear that it works.

That’s the contention of John Graham, who says that “an utterly trivial proportion of the exchange’s target market” have benefited. To be fair, new services sometimes take a long time to gain in popularity. But the record isn’t encouraging so far.

The problem with any state exchange–forced on it by the feds or created internally–is that it must be approved by federal officials.

Maybe, after the 2012 elections, more market- and consumer-friendly people will occupy federal offices. Or perhaps–after the Supreme Court ends its term next June–the Affordable Care Act (ObamaCare) will be history. Even then, however, there will be significant features of the healthcare policy landscape that will blunt the good that an exchange might due.