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A Primer on Health Care Exchanges

It seems like a simple idea: Create new marketplaces, called “exchanges,” where consumers can comparison shop for health insurance — sort of like shopping online for a hotel room or airline ticket.

But, like almost everything else connected with the health-care overhaul law, state-based insurance exchanges are embroiled in politics. Some Republican governors are threatening to refuse to set up exchanges unless they get more flexibility over Medicaid, the state-federal health program for the poor. Others say they don’t want to implement any part of the federal health-care law.

Last week, Louisiana officials decided against setting up an exchange. And in Montana, GOP lawmakers killed a GOP-sponsored Senate bill to set up an exchange. Still, some Republican officials are embracing them. And consumer advocates, disease groups and industry lobbyists are jockeying for influence over how the exchanges will be regulated. 

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