State Health Insurance Exchange Laws: The First Generation

July 25, 2012

Authors: Sara Rosenbaum, J.D., Nancy Lopez, J.D., M.P.H., Taylor Burke, J.D., L.L.M., and Mark Dorley, M.P.H.
Contact: Sara Rosenbaum, J.D., Harold and Jane Hirsh Professor of Health Law and Policy, School of Public Health and Health Services, The George Washington University
Editor: Chris Hollander


Health Exchange Map



Health insurance exchanges are the centerpiece of the private health insurance reforms included in the Patient Protection and Affordable Care Act. As of May 2012, 13 states, together with the District of Columbia, had taken legal action to establish exchanges, through legislation or executive order. State implementing laws are essential to the translation of broad federal policies into specific state and market practices. Overall, the laws in the 14 jurisdictions vary, but they tend to show a common approach of according exchanges much flexibility in how they will operate and what standards they will apply to the insurance products sold. In all states, these "threshold policies" will be followed by policy decisions, expressed through regulations, guidelines, and health plan contracting and performance standards.


S. Rosenbaum, N. Lopez, T. Burke, and M. Dorley, State Health Insurance Exchange Laws: The First Generation, The Commonwealth Fund, July 2012.

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