Health Exchanges

Health Reform: Health Exchanges

health insurance


The first open enrollment period for private insurance plans offered through state and federal marketplaces ended March 31, 2014. Last week, the Department of Health and Human Services released final enrollment numbers for this first year. State legislators and staff are using this opportunity to evaluate their own state’s outreach and enrollment efforts, how they compare with other states, and what actions they may want to take to prepare for the next open enrollment period, which begins on Nov. 15, 2014.




  • 2014 ACA Database Expands: On Sept. 9, NCSL updated latest state legislative actions related to health reforms. The online database now provides one-click access to 1,132 bills and resolutions. Sort by state or topics, including Exchanges, Medicaid, Insurance Reforms, Funding or Opt-outs. So far,198 measures have been signed into law or adopted
  • Federal Law full text - read or print the Affordable Care Act  [PDF, 902 pp.]


Exchanges are, for most states, new entities that will function as a marketplace for buyers of health insurance, giving them options & prices for health coverage. The Affordable Care Act requires health insurance exchanges to be established and working in every state. The ACA gives states the option to establish one or more state or regional exchange(s), or partner with the federal government to run certain functions of the exchange. If a state chooses not to create an exchange, the federal government will set up the exchange(s) in the state.  Seventeen states are running their exchanges, seven have partnered with the federal government and the others have deferred to the federal government to run them. These decisions can be changed by states in 2014 or beyond.

NEWS: April 2014 was a "clean up and catch up" time for enrollment for many individual market exchanges; small business (SHOP) exchanges contiue to offer policies through 2014, including incentives up to 35-50% for certain businesses with up to 25 FTE employees offering first-time coverage.   [NCSL Online report updated 8/10/2014]

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NCSL Summit Resources


  • State Actions to Address Health Insurance Exchanges

    Read this NCSL report for October 2014 information on state actions and responses to implement exchanges as outlined in the Affordable Care Act. This material includes links to implementation activities, with 2015 deadlines and enrollment figures by state. It also includes state information about insurers and premiums.

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