The Illinois Senate took a key step toward implementing the Affordable Care Act, also known as "Obamacare." Senators approved the creation of a "health insurance exchange." Starting next year, Americans must have insurance or face penalties. Under the Affordable Care Act, states have the option to create their own health insurance exchanges or partner with the federal government. A health insurance exchange is at the heart of the Affordable Care Act. It's a marketplace where people who don't otherwise have insurance -- like through an employer -- are supposed to be able to find it.