Many of the ACA's arrangements include an expansion of the personal insurance market. It produces rewards for employers to supply health insurance and originally needed that almost all people not covered by their employer or a government insurance program (for instance, Medicare or Medicaid) purchase private medical insurance (private mandate).The ACA needs development of medical insurance exchanges, which are government-regulated, standardized health insurance that are administered and offered by personal insurance provider. why doesn't the us have universal health care. Exchanges might be developed within each state, or states may collaborate to run multistate exchanges. The federal government likewise may establish exchanges in states that do not do so themselves.