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

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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.