The Obameter

Create a National Health Insurance Exchange

Create a "National Health Insurance Exchange to help Americans and businesses purchase private health insurance."


Health care law creates state-based exchanges

President Barack Obama signed health care legislation into law on March 23, 2010. The law calls for the creation of state-based health insurance exchanges, which are virtual marketplaces where people can go to buy health insurance.

But during the campaign, Obama, promised to create one national exchange, a significant difference.

During the run-up to the final passage, experts weighed in on important differences between a single national exchange and 50 different state-based exchanges.Many Democrats and groups advocating health care reform favored a single national exchange, so that the federal government could enforce uniform standards, even in states with minimal regulation of insurers.

But state officials argued that they were in the best position to implement the exchanges, because most current health insurance regulation happens on the state level.

The issue of national versus state exchanges had several interesting pros and cons, said Elizabeth Carpenter, writing in a January 2010 report for the New American Foundation, a nonpartisan public policy institute.

"If we give too much power to the states, can late-adopters and outright opponents stand in the way of progress?" Carpenter wrote. "And if we centralize the exchange, do we risk thwarting state ingenuity and local knowledge?"

The question became moot, however, when Democrats in the Senate lost their 60-seat majority with the election of Republican Scott Brown of Massachusetts in January. That led the House of Representatives to approve the Senate plan with its state-based exchanges.

Because the law includes the state-based exchanges, not one national exchange, we rate this promise a Compromise.


Thomas, HR 3590, Sec. 1321, (health care legislation), March 23, 2010

New America Foundation, Health Reform: National or State Exchanges?, Jan. 14, 2010

The Wonk Room, The Differences Between The House And Senate Exchanges, Jan. 11, 2010

The New Republic, Sexy? No. Important? Yes., Jan. 11, 2010

National Public Radio, House, Senate View Health Exchanges Differently, Jan. 12, 2010

Biographical directory of the U.S. Congress, Scott P. Brown

The New Republic, Jost: Pass the bill now, Jan. 20, 2010

Health reform bill creates a health insurance exchange

After months of talking about health care reform, the U.S. House of Representatives introduced major legislation to overhaul the nation's health care system. House Democrats unveiled the 1,000-plus-page bill, called America's Affordable Health Choices Act of 2009, on July 14, and it includes most of President Barack Obama's key proposals on health reform.

One of Obama's promises was to create a national health insurance exchange. He envisioned people being able to one-stop shop for health insurance, with benefits and coverage spelled out in clear, standardized language.

The House bill creates the National Insurance Exchange under a Health Choices Administration, with a commissioner to run it named by the president. The Health Choices commissioner "establishes a process through which to obtain bids, negotiate and enter into contracts with qualified plans, and ensure that the different levels of benefits are offered with appropriate oversight and enforcement," according to a summary of the legislation from the House Ways and Means Committee.

We should be clear that there's a long way to go — maybe months — before the bill creating the exchange becomes law. It has to pass the House and get through the Senate, where many changes could be made.

Nevertheless, the bill marks significant, measurable progress on Obama's promise, and we rate it In the Works.


Thomas, HR 3200 , introduced July 14, 2009

U.S. House of Representatives Energy and Commerce Committee, House Democrats Introduce Bill to Provide Quality, Affordable Health Care for All Americans , July 14, 2009

U.S. House of Representatives Committee on Ways and Means, Markup of H.R. 3200, America"s Affordable Health Choices Act , July 16, 2009