What will happen next week, when the 51 public health insurance exchanges open for business? In many cases very little.

The October 1 launch of the state-based exchanges, including a separate Web site for the District of Columbia, is clearly an important milestone for U.S. health care reform and the Affordable Care Act, which authorizes the online insurance markets. Public attention has been focused on this date, and there is the very real chance of an embarrassing systems crash or a series of operational miscues that could delay enrollments, generate negative publicity and potentially jeopardize sensitive data.

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