When Congress passed the Patient Protection and Affordable Care Act in 2010, it required states and the District of Columbia to set up health care exchanges by 2014 to help the uninsured, self-insured, low-income earners and small-business owners purchase health insurance coverage at competitive rates previously available only to large business enterprises.

D.C. became the first jurisdiction in the nation to comply when it established the D.C. Health Benefit Exchange Authority. The District has already received more than $82 million in federal grants to set up its exchange. The city’s own website notes: “Nobody will be required to purchase health insurance through the Exchange … If you would prefer to buy your insurance through an insurance agent or broker, you will be free to do so.”