Establishing Health Insurance Exchanges: An Overview of State Efforts

Kaiser Family Foundation

November 29, 2012

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Following the Supreme Court's decision to uphold the Affordable Care Act (ACA) and preserve the individual mandate, state-based health insurance exchanges remain a key component of the ACA. Exchanges will be the mechanism through which millions of low and moderate-income individuals receive premium and cost-sharing subsidies to make private health coverage more affordable and where employees of small businesses will be able to purchase coverage. States can elect to build a fully state-based exchange, enter into a state-federal partnership exchange, or default into a federally-facilitated exchange. Exchanges are required to be fully operational in every state by January 1, 2014, and their readiness will be evaluated by the federal Department of Health and Human Services (HHS) one year prior to opening. States planning to operate a state-based exchange or a state-federal partnership exchange are required to submit an exchange blueprint consisting of a declaration letter signed by the Governor and an application to HHS by November 16, 2012. Given these fast approaching deadlines and that most states' legislative sessions have come to a close, states face serious challenges to making the necessary policy and implementation decisions.