Texas State government has decided not to implement the health insurance exchange that’s mandated federal law. Republican Governor Rick Perry strongly opposed the Affordable Care Act and threatened to reject any law pertaining to the implementation of a Texas health insurance exchange.According to Rep. John Zerwas, MD, who sponsored the bill to create the Texas exchange, Gov. Perry is emphasizing that he does not want to be involved in the execution of health care reform in any possible way.In contrast, the Texas Medical Association supports the Zerwas bill. Special grants would be offered to those with earnings at 400-percent of the federal poverty line to help them buy coverage through the exchange.By January 2013, the Department of Health and Human Services will screen health insurance exchanges that have been created by different states. If these are deemed fit to operate in accordance with the health care reform law by 2014, states will retain control. If not, the federal government will step in to fulfill health care reform.Steve Larsen, director of the HHS Center for Consumer Information and Insurance Oversight, says that states who fail to enact their own exchange will have a second chance. They need to submit notice 12 months in advance, though.What Is The Texas Health Insurance Exchange Alternative?Gov. Perry approved a bill to create “health care collaboratives.” Under this bill, health care organizations that take on the financial risk for treating consumers will be categorized as TX health insurance. Physicians will be given the opportunity to participate in more than one of these collaboratives.Another alternative has been making news, too. In Camden, New Jersey, which is infamous as one of the poorest and most violent cities in the nation, an innovative idea has cut the cost of healthcare by 40 to 50 percent.An official from the Obama administration and two members of Congress have already visited the city to some the new strategies. One idea is to bring health care to those who need it most. Two hotspots showed up as epicenters for the biggest medical bills. One of those areas was an apartment building for 300 disabled or elderly people. The reason why health care was so costly here was not the sheer volume, but that expensive emergency care was being substitutes for preventive care. They turned the cost of health care upside down here by adding a nurse practitioner’s office in the building.Having regular preventive care check-ups not only saved money, but also improved the quality of life for many of the apartment’s residents because they received better care than what was available via the E.R.Will A Texas Health Insurance Exchange Improve Preventive Health Care?The health insurance exchange also stands to move people who couldn’t previously afford TX health insurance out of the E.R. When more people have access to preventive health care, we may see a reduction in medical expense throughout most large cities.If one of the poorest cities in the nation can cut medical costs by 40 to 50 percent while improving the quality of health care and reducing the need for health care, what stands in the way for other cities? Could it be that those who profit from high-priced emergency room care are holding us back?