Many states are creating health exchanges to deliver better value for consumers, and other states should follow their lead, according to Making the Grade, a new report by consumer group RIPIRG. Health exchanges are competitive marketplaces that can empower individuals and small businesses with better, more affordable options for coverage. Under the federal health reform law, each state will have an exchange up and running in 2014. The report closely examines the exchanges that have so far been set up by states and rates them according to how accountable they will be to consumers and the public, how much they can do to lower premiums and improve the quality of care, how friendly they will be to consumers, and how stable they will be.