In 2013 some 197 million Americans have commercial health insurance, through employers, individual purchases or policies with public subsidies. Now federal health reform adds to existing state regulation, mandates and consumer protections. Starting October 1, 2013 uninsured or underinsured residents in all 50 states have a new option to use a Health insurance Marketplace or Exchange to buy a health policy. Large employers face a future requirement to offer health insurance, while smaller employers can obtain an incentive subsidy if they opt to offer coverage. NCSL has extensive information describing current laws, pending bills and latest federal guidance and rules from HHS.