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Health Policy Brief

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Health Insurance Exchanges and State

Decisions. Exchanges must be ready to begin

enrolling people by October 2013. How is each

state preparing?

what’s the issue?

The Affordable Care Act (ACA) established

health insurance exchanges—also known as

“marketplaces”—in each state as a cornerstone of its health coverage expansion and

insurance-market reforms. Exchanges will

serve as portals through which individuals

and small businesses can compare and purchase private health plans that have been

“certified” as meeting federal and state standards. Exchanges will also allow individuals

with low-to-moderate incomes to access public coverage programs, such as Medicaid and

the Children’s Health Insurance Program, or

financial assistance to purchase private coverage. Certain small businesses also will be able

to access tax credits for employee coverage

through exchanges. According to the Congressional Budget Office, an estimated 9 million

people will enroll in coverage through individual and small-business exchanges in 2014,

increasing to 29 million by 2022.

©2013 Project HOPE–

The People-to-People

Health Foundation Inc.

10.1377/hpb2013.14

Under the Affordable Care Act, states may

establish and run the exchange in their state,

or they may defer responsibility to the federal

government. Since the law was enacted, the

Department of Health and Human Services

(HHS) has created multiple variations of these

two options that provide greater flexibility to

states to take on responsibility for some, but

not all, functions.

By January 1, 2014, all states must have an

operational individual and small-business

exchange, regardless of whether it is run by

the state or the federal government. In practice, exchanges are supposed to be ready by

October 1, 2013, the start of the initial open-­

enrollment period. Although all exchanges

will be built off a common framework set...