Before the Affordable Care Act was passed in 2010, Massachusetts had a health care mandate and Utah had a health exchange. Utah’s market-based exchange is a Web portal where four of the state’s five largest health insurance companies offer roughly 140 plans to about 6,000 employees of 285 small businesses. Originally, Utah wanted to tie private health insurance to individuals instead of employers, but decided such a step would have to wait until federal tax law stopped favoring employer contributions over individual contributions. For now, Utah’s exchange aims to “plant the seed for defined contribution health care,” said Norman Thurston, the man most responsible for getting the exchange up and running. Utah Gov. Gary Herbert is not pleased with President Obama’s health reforms. “Obama has come along and spoiled the name ‘exchange.’” Herbert said a contest will be held to rename the Utah Health Exchange.

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