Because he doesn’t like Obamacare, future Governor Mike Pence has recommended something of a passive-aggressive course of action by Indiana in terms of (not) establishing a state-based health insurance exchange under the Affordable Care Act. His letter to Gov. Daniels is here. This has the effect of increasing the federal control over Indiana’s health care system. (This might not be a bad thing, policy-wise, but choosing increased federal control is a departure from Pence’s stated philosophy about wanting to reduce the federal government.)
Under the terms of federal law, states “may opt out of running their own exchange, in which case the federal government will step in to create an exchange for use by their citizens.”
Wikipedia has an explanation of the health care exchange concept here. Generally speaking, it creates one stop shopping for consumers where they can get an apples-to-apples comparison of policies; at least for a basic benefit package. Policies offered through the exchange: 1) Must be guaranteed issue: insurers will not be permitted to refuse to insure any individuals; 2) Must limit price variations: prices will vary based on four factors and not beyond a total factor of approximately 10; 3) Will be offered in four comparable tiers ranging from bronze to platinum with limited out of pocket expenses; 4) Have strict regulations on rescission (practice by which insurers take your premiums until you get sick then disqualify you for technical defects in your application); and 5) Lifetime and annual limits eliminated.