SCI -- Health Care Exchanges: Key Issues for State Implementation

This issue brief delves into some of the details of the health insurance Exchange, as defined by the ACA, and highlights a number of key issues for states to consider, including:

• Governance structure and administration;
• Key functions and responsibilities;
• Operation of the Exchange alongside the state’s commercial health insurance markets;
• Rules governing carrier participation in the Exchange;
• Risk selection, inside and outside the Exchange;
• The interaction between the Exchange and the state’s Medicaid and CHIP programs; 
• The type and level of customer service that the Exchange will need to provide; and
• Whether states should establish their own Exchange or defer that responsibility to the federal government.