It's no wonder Maryland families are so hard pressed to find good, affordable health insurance — premiums have outpaced earnings, and the field of insurance options is confusing. Even if a family is fortunate enough to have coverage, it's hard to know if what you're paying for is going to be there for you when you need it. That's why our Health Care for All Coalition is so excited about Gov.Martin O'Malley's health care bill (SB 238). By setting up a competitive insurance marketplace for private health insurance, also known as an exchange, this bill will give Marylanders more choice, more control and more peace of mind about their health care.

In Maryland, the average premium for family coverage in an HMO went up 42 percent in just six years, from $9,573 in 2004 to $13,613 in 2010. At the same time, the median family income declined 2 percent (adjusted for inflation). As a result of this disparity, 14.5 percent of non-elderly Marylanders, or 720,000 people, are uninsured. Given the recent economic turmoil, this would have been even worse but for the expansion of health care coverage in recent years to more than 300,000 Marylanders, funded in large part by a lifesaving increase in the state tobacco tax.

Fortunately, the federal health care law known as the Affordable Care Act has created a tremendous opportunity for states to make health care more affordable by creating exchanges that are better marketplaces for private health insurance. The O'Malley administration's bill takes advantage of this opportunity and leads the country in implementing a stronger, redesigned health care system.

First, the bill makes health care more affordable by changing the state's health insurance rules to assure fair competition among health plans. This bill gives the exchange the power to get health insurers to compete to offer the best plans. We believe that it will be the catalyst toward moving our health care system to be more effective, efficient and responsive to patients' needs. Fair competition on cost and quality is an important step toward accessible, affordable, high-quality health care.

Second, the bill gives Maryland consumers more control over their coverage. Consumers can choose whether to buy their coverage in the exchange or not. Those who elect to do so may earn considerable savings in the form of tax credits and federal subsidies. The exchange will have certified "Navigators" in our communities to help small businesses and individuals understand all of their insurance options and assist them in signing up for the best deal for them.

Most importantly, Governor O'Malley's bill will give Maryland families peace of mind that the coverage they are paying for will be quality, affordable care. Changing the way health care is delivered in this new exchange will encourage doctors to spend more face time with their patients, make preventive services more affordable by offering them at no cost to the patient, expand the use of electronic medical records, and encourage team-based, patient-centered medical care. And thanks to the federal health care law, Marylanders can rest assured that insurance companies can't drop us or limit our benefits when we get sick or deny us coverage because of a pre-existing condition.

If you are currently getting health insurance through your employer or purchasing insurance through a broker, this bill won't change anything you like about your situation. The current health care insurance markets don't go away. But if you want to shop around for a better deal, need help paying for your premium or haven't yet gotten covered, the exchange will be there for you if this bill is passed.

There is a lot to do to get the health insurance exchange up and running by Jan. 1, 2014, as required by the federal health care law. We believe this bill puts Maryland on the path to build one of the best health insurance exchanges in the country. We plan to work closely with the administration and the General Assembly to improve the bill as much as possible before it is finally passed.

Vincent DeMarco is president of the Maryland Citizens' Health Initiative. His email is demarco@mdinitiative.org.