Requires each state to create an Exchange to facilitate the sale of qualified benefit plans to individuals, including the federally administered multi-state plans and non-profit co-operative plans. A catastrophic only policy would be available for those 30 and younger. In addition the states must create “SHOP Exchanges” to help small employers purchase such coverage. Coverage in the Exchange will only be offered on a pre-tax basis if it is purchased through an employer. The state can either create one exchange to serve both the individual and group market or they can create a separate individual market exchange and group SHOP exchange. States can also apply for a modification waiver from DHHS.