The insurance exchange system — the cornerstone provision of the Affordable Care Act — is undoubtedly the most important and most hotly debated element of the health care reform. After all, the online marketplaces are the most far-reaching change to the American health system in decades.
Given the sweeping social, economic, and political ramifications of the individual insurance mandate that requires everyone — except those who qualify for a hardship exemption — to purchase coverage, the law has had a rocky history. Its passage in 2010 came without a single Republican vote, challenges to the law put the constitutionality of the individual mandate on the docket of the Supreme Court, and the glitch-riddled rollout of the insurance exchanges in October put the viability of the reform in question.
But the largest test of the Affordable Care Act is now upon the Obama administration: As of January 1, Americans will be using the coverage offered through the exchange system.