Even small states like Iowa (total population ~3 million) are going to have 10s of thousands of people on the individual exchanges. That's bigger than all but very large corporations (who tend to self insure anyways).

I hear you about universal health coverage. I've come around to the idea that we should have it at the national level above some sort of cap. I think free markets can still work when it comes to your annual checkup or small expenses like a broken arm or a monthly prescription for non esoteric drugs.