If you are going to allow insurance companies to sell their plans on a national basis you need a national regulator to oversee them. While having the Secretary of HHS serve this function would be preferable, the Office of Personnel Management can be enlarged to do this.
Despite earlier reporting, the new OPM exchange will not be only for non-profit health insurance plans. It will only require that there be at least one non-profit plan in the program, but will also allow for-profit insurance companies to take part. This makes the already weak OPM exchange idea even weaker than the one originally floated a few weeks ago.
Unlike the "nationwide" plans there is no state opt-out for the new OPM exchange. Whether the OPM exchange within other exchanges can ever work in practice is still an open question. My support for this change is not that I think this new OPM exchange is in itself a great idea. I think this change is a positive development because it would eliminate what I think was an extremely destructive idea in the original bill.
Update - The OPM exchange requires only that one of the plans offered be a non-profit plan and that at least one plan offered not cover abortion. This, in theory, could result in women not having access to a non-profit plan in the new OPM exchange that does cover abortion, since the one non-profit plan offer could also be the one plan that doesn't cover abortion.
Update 2 - The CBO shares my concern and is doubtful if the OPM exchange program would even be able to function properly.
The proposal would call on OPM to contract for two national or multi-state health insurance plans—one of which would have to be nonprofit—that would be offered through the insurance exchanges. Whether insurers would be interested in offering such plans is unclear, and establishing a nationwide plan comprising only nonprofit insurers might be particularly difficult. Even if such plans were arranged, the insurers offering them would probably have participated in the insurance exchanges anyway, so the inclusion of this provision did not have a significant effect on the estimates of federal costs or enrollment in the exchanges.