Designing an Exchange

A Toolkit for State Policymakers

Health insurance exchanges—a key element of the Patient Protection and Affordable Care Act (ACA)—are intended to offer individuals and small employers a wide selection of options for purchasing more affordable, high-quality health insurance. The law gives states considerable discretion in structuring many elements of the exchange, including issues related to governance and structure, financing and authority. It also allows states to establish one or more sub-state exchanges serving geographically distinct areas within a state. And if a state does not wish to establish an exchange, the law states that the federal government will operate an exchange in the state.

To assist states with the design of health insurance exchanges, the National Academy of Social Insurance (NASI) has released a legislative toolkit, the first product of a larger NASI project funded by the Robert Wood Johnson Foundation to provide technical assistance to states developing health insurance exchanges. This toolkit offers options in a number of key areas, including governance, establishment of SHOP exchanges for small employers, eligibility determination and enrollment, certification of qualified health plans and coordination with Medicaid and the Children’s Health Insurance Program (CHIP).