The Experiences of State-Run Marketplaces That Use HealthCare.gov

Interest in new implementation approaches to health insurance marketplaces has increased as states seek to ensure the long-term financial stability of their exchanges and exercise local control over marketplace oversight. This brief explores the experiences of four states—Idaho, Nevada, New Mexico, and Oregon—that established their own exchanges but have operated them with support from the federal HealthCare.gov eligibility and enrollment platform. Drawing on discussions with policymakers, insurers, and brokers, this brief examines how these supported state-run marketplaces perform their key functions.