 Secondly it set forth provisions governing the establishment and operation of state-based health care exchanges to facilitate the individual purchase of private health insurance and the creation of a market where private health plans compete for enrollees based on price and quality.Thirdly it intended to amend the Internal Revenue Code to allow a refundable tax credit for qualified health care insurance coverage.Fourth it sets forth programs to prevent Medicare fraud and abuse, including ending the use of social security numbers to identify Medicare beneficiaries.