The Launch of Health Reform in Eight States: State Flexibility Is Leading to Very Different Outcomes

This paper provides a review of a series of papers that examine early implementation of the Affordable Care Act in eight states, and the very different design choices that they have made in implementing the law. The paper examines coverage expansion; financial impacts; the development of information technology systems; outreach, education and enrollment assistance; insurer participation, competition and premiums in marketplaces; insurance market reforms; development of SHOP marketplaces; and issues of provider capacity. The law will work very differently for residents in different states around the country and there will be different outcomes both in terms of coverage and economic impacts.