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.