To create as a state entity the "exchange" mandated by the federal "Patient Protection and Affordable Care Act," the primary purpose of which will be to administer the insurance subsidies provided by that law to households up to 400 percent of poverty level (around $80,000 for a family of four in Michigan). Called the "MIHealth Marketplace," this non-profit agency would create a website on which individuals can select an insurance policy that complies with PPACA mandates, and have eligibility determined for the law's subsidies.

If the state has not made "measurable progress" toward creating an exchange by the start of 2013, the federal government could choose to create its own version for the state. Among other things, this entity would also determine whether particular individuals are subject to the PPACA's "individual mandate" to purchase insurance. It would not be subject to the state Freedom of Information Act, and its operations would be funded by imposing fees on insurance providers.