State Progress in Implementing Health Insurance Exchanges: Results from 10 State Analyses


This report from the Robert Wood Johnson Foundation, part of its Affordable Care Act (ACA) Implementation—Monitoring and Tracking series, examines the status of health insurance exchange development and design choices in 10 featured states. Under the ACA, each state has the option to develop an exchange, an organized marketplace to purchase health insurance in the small group and nongroup markets. While there are a number of federal regulations with which a state-operated exchange must comply, there is also considerable flexibility in development and design.

Key Findings

  • Although progress in implementing exchanges varies considerably across states, policy-makers, stakeholders and consumer advocates have been universally highly engaged in the process.

  • In interviews, the authors found that a state-run exchange was largely preferable to a federally run one.

  • There was considerable consensus that the state’s interests would be best served if the exchange could be tailored to the state’s preferences as much as possible.

This report is one of a series papers focusing on ACA implementation issues uncovered in Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia.