•    There is nothing about the exchange that increases the affordability of health insurance. In fact, the exchange, as envisioned, adds around 5 percent to the cost of each person’s premium.

•    The exchange is a new layer of bureaucracy that duplicates many of the responsibilities of the state insurance commissioners. Rather than just create an easy venue for comparison shopping, the House bill creates a new layer of bureaucracy in the health care system that will add costs rather than subtract them.

•    The affordability of insurance is dictated by three things, with the underlying cost of health care services being the most important of the three. Nothing in the House bill addresses in any meaningful way the incentives inherent in the health care system for patients, physicians and hospitals to prefer to do more and more tests and give more and more services. There is little accountability for outcomes.

•    Merely adding a layer of bureaucracy regulated by an all-powerful health care czar as a centralized shopping mechanism does not make the coverage more affordable. Indeed, the majority has required coverage for many more services that have not been proven to save money and will instead merely add to the cost of the coverage.

•    There does not appear to be a mechanism for people to use their trusted insurance brokers to help them make decisions on coverage when buying through the exchange. People will have to rely on a government 1-800 number for help, and if Medicare is any example, the answers will vary depending upon which telephone operator answers the phone on any given call.