Enhancing the Patient-Centeredness of State Health Insurance Markets


Exchange Operational Models

The ACA established sweeping insurance reforms that included the introduction of health insurance exchanges, where individuals and families can shop for health insurance coverage. While each state has its own exchange, the federal government plays a role in managing exchanges in many states. In general, states followed one of three paths to establish an exchange—a state-based exchange, a state-partnership exchange in which the state and federal government share exchange responsibilities, or a federally-facilitated exchange. Each model envisions a different role for states, and, as a result, the federal government. However, the federal government sets basic operating standards for all exchanges. 

The Role of States

Each exchange model relies on states to ensure that plans comply with state insurance laws and to enforce some aspects of the ACA. Therefore, every state has the opportunity to establish additional standards and requirements that ensure patients have access to coverage that meets their needs. 

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