State-Level Progress in Implementation of Federally Facilitated Exchanges

Health insurance exchanges are one cornerstone of the Affordable Care Act, offering structure and organization to the small group and non-group health insurance markets. States can choose to operate their own exchange; however, the law also provides for federally run exchanges for states unable or unwilling to run their own. There is inherently less opportunity for customization in a federal exchange than there is in a state-run exchange, but not all exchanges look alike.

This report highlights three case studies of states (Alabama, Michigan, and Virginia) opting for the latter option and the roles they are playing in the implementation process and will play once the exchange is operational.

Key Findings

  • Two of the three states are actively engaged in their exchange’s development, although some stakeholders noted they need more information from the government to complete the exchange.

  • State Departments of Insurance view the regulations and their role in the exchanges as a continuation of their work pre-reform.

  • States are at different stages of readiness as a result of varying political/administrative hurdles.

  • Consumer assistance programs will need to be created to help people navigate the exchange, although clearing political hurdles will be a challenge in the acquisition of federal funds to pay for such programs.

The report also looks at the unique challenges facing FFEs, from consumer assistance programs and funding to the political environments at the national and local levels.