Health Exchanges

Health Reform: Health Exchanges

health insurance


The second year open enrollment period for private insurance plans offered through state and federal marketplaces ran for three months, Nov. 15 to Feb. 15, 2015. Latest results show 11.4 million enrolled. Individuals with qualifying events such as a marriage, job change, birth or move out of state still may enroll between now and November 2015. NCSL's report has the 50-state history and this year's plans and pricing.  A 60-page supplement details each state.




  • 2014 ACA Database Expands: NCSL has updated latest state legislative actions related to health reforms. The online database now provides one-click access to 1,194 bills and resolutions. Sort by state or topics, including Exchanges, Medicaid, Insurance Reforms, Funding or Opt-outs. So far, as of Dec. 29, at least 235 measures have been signed into law or adopted.
  • Federal Law full text - read or print the Affordable Care Act  [PDF, 902 pp.]


Exchanges are entities that function as a marketplace for buyers of health insurance, giving them options and 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 2015 or beyond.

NEWS: On Nov. 15, 2014 exchanges opened again for second year enrollment; small business (SHOP) exchanges contiue to offer policies through 2015, including incentives up to 50% for certain businesses with up to 25 FTE employees offering first-time coverage.   [NCSL Online report updated 11/17/2014]

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  • State Actions to Address Health Insurance Exchanges

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

  • Health Insurance Premiums and Premium Costs by State

    Actual health insurance premiums and rates presented nationally and by state for 2014 and 2015. Table includes historical trends and links to the best sources, including a Commonwealth Fund-designed interactive map.

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