Insurance companies are not required to participate in the exchanges (and many don't). And while people are required to buy insurance, they aren't required to b

Insurance companies are not required to participate in the exchanges (and many don't). And while people are required to buy insurance, they aren't required to buy it from the exchanges (many will still get insurance via their employers, for example). Both sides are choosing to use the exchanges rather than one of their alternatives, so the fees paid are user fees, not disguised taxes (unless you consider all user fees disguised taxes, which is a separate philosophical discussion).