Exchanges will also steer low-income people to state Medicaid programs. The law gives states the option to expand Medicaid to cover more of their low-income residents, with the federal government picking up about 90 cents of every dollar in added costs.
Coverage through exchange plans will begin on Jan. 1, 2014.
At the same time, the law will require most Americans to carry health insurance, either through an employer, a government program, or by buying their own policies. Insurance companies will be barred from turning away the sick or charging them more. And insurers will also be limited in what they can charge older customers.
Associated Press writer John Miller in Boise, Idaho, contributed to this report.
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