Health Exchanges

Health Reform: Health Exchanges

health insurance


Health Insurance Exchanges or Marketplaces have been a focal point for state legislatures.The 2010 Affordable Care Act (ACA) gives states the option to establish a state-run exchange, partner with the federal government, or let the federal government run the exchange. NCSL has extensive information on implementation across all 50 states since exchanges went live on Oct. 1, 2013. See this month's details in the NCSL online report.

American Health Benefit Exchanges. This NCSL federal affairs online alert has material on the ACA's legal requirements, as well as latest regulations and developments from Washington.



  • 2014 ACA State Database: NCSL has just released its latest compilation of 2014 state legislative actions related to the Affordable Care Act, with one-click access to almost 1,000 bills and resolutions filed or pending across the 50 states and D.C. Legislation can be sorted by state and by topics including Exchanges, Outreach, Insurance Reforms and others. As of this week, at least 75 measures have been signed or adopted. 
  • Federal Law full text - read or print the Affordable Care Act  [PDF]


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: March 2014 is the 6th and final month of open enrollment for all 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.   [Online report updated 3/6/2014]

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NCSL Summit 2014


  • State Actions to Address Health Insurance Exchanges

    Read this NCSL report for 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 extended or postponed deadlines and enrollment figures by state. It also includes state information about insurers, premiums and allowing insurance renewals or cancellations.

  • Health Insurance Marketplace Updates

    Read recent updates following the 6-month open enrollment period for Health Insurance Marketplaces created in the Affordable Care Act (ACA) which ended March 31, 2014. State and federal rules allow new options and extensions for some consumers. Read about recent activities that affect state run and federally-facilitated marketplaces;

  • Health Insurance Reform Enacted State Laws Related to ACA

    More than 45 states have enacted one or more :Health Insurance Reform Enacted State Laws Related to the Affordable Care Act," between 2011 and 2013, with significant variations across the country. More such laws are being enacted in 2014 sessions.

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