One of the health care reform bill reforms that won't start until 2014 is the implementation of "insurance exchanges." Instead of the public option--where the government provides both the pool of customers and provides the health care--with the insurance exchange, the government simply creates the pool of customers. We can go "shopping" in the exchanges for health insurance options.
The idea is that the exchange system will promote more price competition between insurance companies, and since the government regulates the exchange, it can exert downward cost pressure on them, too. Participants will have to demonstrate, for instance, that they're spending the majority of their money on providing health care services, rather than on overhead. But Seattle may lead the way in cost competition for another reason entirely. HR 3590, the Patient Protection and Affordable Care Act, allows flat-fee direct primary care practices ("medical homes") into the exchanges.