Health care exchanges are an attempt by health care reform designers to simplify the search for medical insurance for small businesses and individuals. Described as an insurance marketplace for small businesses and individuals not covered by employer plans, exchanges must be established in each state by 2014, according to new health care laws.

Although some states have agreed to get a head start and launch exchanges by January of 2013, many Republican governors have said they will not comply unless they get more flexibility over Medicaid.

States can opt out, in which case the federal government will step in and run the exchange from those states.

The Congressional Budget Office estimates that 8 million people will use exchanges in 2014, increasing to 24 million by 2018.