Starting in 2014, under the federal healthcare reform law, all states will be required to set up an exchange. If they don't, the federal government will come in and do it for them. When they're fully operational, it's estimated about 30 million Americans will be able to go online and buy health insurance, many of them for the first time. But two states are ahead of the game, Massachusetts and Utah. Utah did it because its 67,000 small business owners, who account for three of every five jobs in the state, were drowning in high costs. To sign up, employers decide how much they can give each worker to buy insurance-- the defined contribution. Then each employee shops online and picks the insurance plan they can afford and that meets their health care needs. Last year, Utah launched its new exchange with a pilot program. And in January, it opened it up to all small businesses. But that's the only group the exchange addresses. Right now, larger businesses and the 300,000 uninsured residents of the state cannot get coverage through the exchange, because state officials were not focused on getting more people insured, a key goal of the federal healthcare reform law.