The idea of encouraging an insurance market place for health insurance has been a favorite idea of health care economists. The key idea was to establish an insurance market place as an alternative to the employer based health insurance. As a person who buys health insurance in the individual insurance market, my view of a health exchange is more along the idea of www.ehealthinsurance.com. The Affordable Care Act proponents decided that by combining a few concepts of market based health insurance with a new mandate to distribute insurance subsidies to the poor, they could convince the states to subsidize the exchanges. It was a political gambit that failed to convince states or people like me to participate. The states figured out that if they did nothing, the federal government would pick up the entire bill for setting up and funding the exchanges. This subsidy issue overwhelms and obscures efforts at encouraging an insurance market place with more competition and lower costs.  Why should I participate in a health exchanges if they are not offering me lower costs and greater choice like I can get by using www.ehealthinsurance.com? 

States have to decide by Feb. 15 whether they will create their own health insurance exchanges, partner with the federal government or allow the federal government to do it for them. Meanwhile, during a congressional hearing marked by skepticism, a Health and Human Services official told lawmakers that the government would be ready to enroll people this fall.

Health Exchanges: Today Is States’ Decision Day
Fri, 15 Feb 2013 15:46:00 GMT