If you want a way of predicting the future, look at someone already doing what you propose. If it works for this person, maybe it will work for you. Obviously, not everyone is the same, but you may see some things to copy and some things to avoid by looking around you. The new Obamacare law requires all states to set up an insurance exchange by 2013. If the deadline passes without an exchange being in place, the federal government will step in. It's working on a one-size-fits-all exchange and this will be imposed to ensure every citizen across all states has access to an exchange come 2014 when the law comes into force. At this point, let's point to Massachusetts and Utah which already have exchanges in place.

Massachusetts has about 6.6 million inhabitants with a good record in health care and preventative medicine. In 2006, the state government mandated more or less all residents to obtain a minimum level of health coverage. Those that refuse must pay penalties. The Commonwealth Connector Authority regulates the market, buying policies for those that cannot afford it and setting premium levels. This ability to reject the premium rates offered by insurers as too high gives the Authority significant power. More importantly, the ability to impose penalties on scofflaws is producing some exciting legal cases. About 7,700 taxpayers have appealed the penalties and, so far, 3,150 have been told to pay up. As with any law based on one rule for all, the more people who refuse compliance, the worse the economics of the law. The premium rates are based on the census information showing the number of people expected to join in the plan. As more people are struggling in the recession, more are refusing to pay either the premiums or the penalties. They are expecting the taxpayers to pick up the bill when they turn up at emergency rooms without cover. This is leading to major enforcement efforts with scofflaws subjected to liens, garnishment and other action. Romneycare in Utah is less interventionist and more like a farmers' market. Many citizens have been confused by the number of choices available and, with the rise of the Tea Party, Mitt Romney may find himself in political trouble for promoting this version of universal care.

Some states are rejecting either model and are investigating whether to set up regional exchanges with multiple states. The politics of this are daunting. However states decide to go, there's one reality to face. Once you make any system mandatory, you have to be seen to enforce it. Should taxpayers get the feeling there are too many freeloaders, support for the law disappears. That's why Massachusetts is being so proactive. Utah is less aggressive but may soon be forced to take action. Because of the state subsidies, the plans sold through these exchanges will be cheap health insurance for those unemployed or on a low income. For everyone else with the income to pay for private coverage, it will be be usual game of checking through health insurance quotes to find the best value policy for your family.