Creating such an exchange would also help accomplish another long-term conservative policy goal: transforming health insurance from a responsibility for employers to a responsibility for individuals.

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Under the Affordable Care Act, the Federal government, State governments, insurers, employers, and individuals share the responsibility to reform and improve the availability, quality, and affordability of health insurance coverage in the United States.

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Earlier efforts to come to an accommodation with religious groups had run into problems because many large employers, including big Catholic institutions, self-insure, meaning they act as insurance companies by assuming the full responsibility for the health costs of their workers and use traditional insurance companies only for administrative services.

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