Health Insurance Marketplaces

Alaska

Federally facilitated marketplace

Alabama

Federally facilitated marketplace

Arkansas

State federal partnership

Arizona

Federally facilitated marketplace

California

Domain	State Approach	Details
Exchange Establishment	Covered California (September 30, 2010)	Senate Bill 900; Assembly Bill 1602
Governance	Quasi-governmental	Independent public entity not affiliated with an existing state agency or department
Board Membership	Five-member board	State Secretary of Health and Human Services, two gubernatorial appointees, two legislative appointees Board members are: Kimberly Belshé, Senior Policy Advisor, Public Policy Institute of California Diana S. Dooley, Ex-Officio, Secretary of California Health and Human Services Paul Fearer, Senior Executive, Vice President, and Director of Human Resources, UnionBanCal Corporation Susan Kennedy, former Chief of Staff to Governor Arnold Schwarzenegger Robert Ross, President and Chief Executive Officer, The California Endowment
Board Conflict of Interest Requirement	Yes	Board members may not be employees, consultants, members, or representatives of: an insurer, an agent or broker, or a health care provider or facility. Providers may serve if they receive no financial compensation for services and do not have ownership interest in a professional practice. Board members may not participate in activities that are financially beneficial to themselves or family members.
Approach to Health Plan Selection	Selective contractor	Contracts only with insurers that advance exchange goals and may manage plan choices through limits on the number or type of plans that an insurer can offer.
Insurer Participation Requirement	No
Coverage Level Requirements	Requires a minimum of five levels of coverage	Insurers in the exchange must propose or offer all five coverage levels: catastrophic, bronze, silver, gold, and platinum coverage. Federal law requires that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Requires some standardized plans, and adopts a meaningful difference standard (health plan choices must be distinctly different from one another).
Health Plans to Display Quality Data in 2014	Yes	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers may offer employees a choice of multiple insurers in one tier.
Consumer Assistance	Navigator and in-person assistance program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Assessment on insurers offering coverage in the individual and small-group markets

Colorado

Domain	State Approach	Details
Exchange Establishment	Connect for Health Colorado (June 1, 2011)	Senate Bill 200
Governance	Quasi-governmental	Independent public agency that is an agency of the state except with regard to debts and liabilities.
Board Membership	12-member board: nine voting and three nonvoting	Voting members: Gretchen Hammer (Chair), Executive Director, Colorado Coalition for the Medically Underserved Richard Betts, Owner, ASAP Accounting & Payroll, Inc. Eric Grossman, Independent Consultant Steve ErkenBrack, President, Rocky Mountain Health Plans Arnold Salazar, Executive Director, Colorado Health Partnerships, LLC (Vice Chair) Nathan Wilkes, Founder and Principal Consultant, Headstorms, Inc. Mike Fallon, Health care provider (Secretary) Ellen Daehnick, Helliemae’s Handcrafted Caramels Sharon O’Hara, Executive Vice President, National Multiple Sclerosis Society, Colorado-Wyoming Chapter Nonvoting members: Susan Birch, Executive Director, Colorado Department of Healthcare Policy and Financing Kevin Patterson, Deputy Chief of Staff and Chief Administrative Officer, Office of Colorado Gov. Hickenlooper Marguerite Salazar, Commission of Insurance, Colorado Department of Regulatory Affairs
Board Conflict of Interest Requirement	Yes	Board members are prohibited from participating in activities with a direct financial benefit to a business in which the member has a substantial or direct financial interest. Majority of board voting members must not be directly associated with the insurance industry or be a state employee.
Approach to Health Plan Selection	Clearinghouse	Allows all plans meeting minimum criteria to participate on the exchange; does not selectively contract with insurers or manage plan choices.
Insurer Participation Requirement	Encourages insurers to participate in the exchange	State prohibits an insurer from entering the exchange for up to two years if the insurer does not participate in 2014. State prohibits an insurer from re-entering the exchange for two years if the insurer voluntarily ceases to participate in the exchange.
Coverage Level Requirements	Requires a minimum of two levels of coverage	Complies with reform law requirement that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	No
Health Plans to Display Quality Data in 2014	Yes	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees a single plan, or a choice of multiple insurers in one tier; one insurer in multiple tiers; or multiple insurers in multiple tiers. Employees choosing plans on the small-business exchange are limited to choosing plans on tiers that are adjacent to the reference plan chosen by the employer (i.e., if the employer selects a silver plan, employees can only choose a plan from among bronze, silver, and gold options).
Consumer Assistance	Navigator program and in-person assistance program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Assessment on insurers offering coverage in the individual and small-group markets

Connecticut

Domain	State Approach	Details
Exchange Establishment	Access Health CT (July 1, 2011)	Senate Bill 921; Public Act No. 11-53
Governance	Quasi-governmental	Nonprofit corporation is not to be construed as a department or agency of the state
Board Membership	14-member board: 11 voting members and three nonvoting members	Nancy Wyman (Chair), Lt. Governor Mary Fox, Former Senior Vice President, Product Group, Aetna Paul Philpott, Principal Consultant, Quo Vadis Advisors LLC Grant Ritter, Senior Scientist, Schneider Institutes for Health Policy Robert Scalettar, Former Chief Medical Officer, Anthem Blue Cross Blue Shield Robert Tessier, Executive Director, CT Coalition of Taft-Hartley Health Funds Cecilia Woods, Former Vice-Chair, Permanent Commission on the Status of Women Maura Carley, President and CEO, Healthcare Navigation, LLC Roderick Bremby, Commissioner, Department of Social Services Victoria Veltri, (Co-Chair) State Healthcare Advocate, Office of the Healthcare Advocate Benjamin Barnes, Secretary, Office of Policy and Management Anne Melissa Dowling Deputy Commissioner, Connecticut Insurance Department Jewel Mullen, Commissioner, Department of Public Health (nonvoting) Patricia Rehmer, MSN, Commissioner, Department of Mental Health and Addiction Services CEO: Kevin J. Counihan
Board Conflict of Interest Requirement	Yes	Board members and exchange employees may not work for or be affiliated with organizations that pose an obvious conflict of interest, i.e, insurance industry organizations, health care providers or facilities, trade associations of insurers, or brokers, while serving. Board members and exchange employees may be health care providers if they are not compensated for the health care services rendered and have no ownership interest in a professional practice. A board member may not be involved with the deliberation, action, or vote affecting an entity under the board’s authority if the member has a financial interest in that entity. Members may not receive compensation; they may receive money to cover necessary expenses incurred in carrying out their duties. Members and employees may not accept employment with any insurer offering quality health plans through the exchange for one year after their service.
Approach to Health Plan Selection	Market organizer	Manages plan choices through limits on the number or type of plans that an insurer can offer but does not selectively contract with insurers.
Insurer Participation Requirement	Encourages insurers to participate in the exchange	State prohibits an insurer from re-entering the exchange for two years if the insurer voluntarily ceases to participate in the exchange.
Coverage Level Requirements	Requires a minimum of three levels of coverage	Insurers in the exchange must offer at least bronze, silver, and gold coverage. Federal law requires that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Limits the number of plans per insurer, requires some standardized plans, and adopts a meaningful difference standard (health plan choices must be distinctly different from one another).
Health Plans to Display Quality Data in 2014	Yes	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees a single plan, or a choice of multiple insurers in one tier or one insurer in multiple tiers.
Consumer Assistance	Navigator and in-person assistance programs	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Assessment on insurers offering coverage in the individual and small-group markets

District of Columbia

Domain	State Approach	Details
Exchange Establishment	District of Columbia Health Benefit Exchange Authority (March 2, 2012)	B19-0002 Act/Resolution # A19-0269
Governance	Quasi-governmental	Housed at the Department of Health Care Finance
Board Membership	11-member board	Diane C. Lewis (chair), health care policy consultant Mohammad Akhter, M.D. Henry J. Aaron, Brookings Institution Kate Sullivan Hare, Robert Wood Johnson Foundation Leighton Ku, Center for Health Policy Research at George Washington University Kevin Lucia, Health Policy Institute of Georgetown University Khalid Pitts, Service Employees International Union Non-Voting Members: Dr. Joxel Garcia, District of Columbia Department of Health, Acting Director Chester McPherson, Department of Insurance Commissioner, Interim David A. Berns, District of Columbia Department of Human Services Wayne Turnage, District of Columbia Department of Health Care Finance
Board Conflict of Interest Requirement	Yes	Board members and exchange employees may not be affiliated with insurers, brokers, or health care providers or facilities while serving. Board members and exchange employees may be health care providers if they are not compensated for the health care services rendered and have no ownership interest in a professional practice. Board members may not participate in board decisions that are financially beneficial to themselves or family members. Board members and staff members are not permitted to work for a qualified health plan issuer that offers qualified health plans in the exchange for one year after ending their service or employment with exchange.
Approach to Health Plan Selection	Clearinghouse	Allows all plans meeting minimum criteria to participate on the exchange; does not selectively contract with insurers or manage plan choices.
Insurer Participation Requirement	Requires insurers to participate in the exchange	State established a single marketplace where all individual and small-group coverage must be sold through the exchange.
Coverage Level Requirements	Requires a minimum of three levels of coverage	Insurers in the exchange must offer at least bronze, silver, and gold coverage. Federal law requires that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Adopts a meaningful difference standard (health plan choices must be distinctly different from one another).
Health Plans to Display Quality Data in 2014	No
Health Plan Choice for Small Businesses	Yes	Employers can offer employees a single plan, or a choice of multiple insurers in one tier, or one insurer in multiple tiers.
Consumer Assistance	Navigator and in-person assistance programs	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Undecided

Delaware

State federal partnership

Florida

Federally facilitated marketplace

Georgia

Federally facilitated marketplace

Hawaii

Domain	State Approach	Details
Exchange Establishment	Hawai'i Health Connector (July 11, 2011)	Senate Bill 1348
Governance	Private nonprofit	Nonprofit corporation subject to state oversight
Board Membership	15-member board	Board members: Christine Maii Sakuda, Hawaii Health Information Exchange Clementina Ceria-Ulep, Faith Action for Community Equity Cliff Alakai, Maui Medical Group Dwight Takamine, State of Hawaii Department of Labor and Industrial Relations Faye Kurren, Hawaii Dental Service Gwen Rulona, UFCW Local 480 Hardy Spoehr, Papa Ola Lokahi Jennifer Diesman, Hawaii Medical Services Association Joan Danieley, Kaiser Foundation Health Plan Inc. Kealii Lopez, Hawaii Department of Commerce & Consumer Affairs Loretta Fuddy, State of Hawaii Department of Health Michael Gleason, The Arc of Hilo Patricia McManaman, Hawaii Department of Human Services. Robert Hirokawa, Hawaii Primary Care Association Sherry Menor-McNamara, Chamber of Commerce of Hawaii.
Board Conflict of Interest Requirement	Yes	The board will adopt policies prohibiting conflicts of interest and procedures for recusal, including policies that prohibit members from taking part in any action in which the member had a financial interest prior to service on the board. Board members may not be state employees.
Approach to Health Plan Selection	Clearinghouse	Allows all plans meeting minimum criteria to participate on the exchange; does not selectively contract with insurers or manage plan choices.
Insurer Participation Requirement	No
Coverage Level Requirment	Requires a minimum of two levels of coverage	Complies with reform law requirement that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	No
Health Plans to Display Quality Data in 2014	No	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees a choice of multiple insurers in one tier, or multiple insurers in multiple tiers, or all insurers in all tiers. These options are only available for employers not subject to the requirements of Hawaii's Prepaid Health Care Act.
Consumer Assistance	Navigator and in-person assistance programs	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	2% issuer fee on monthly premiums for qualified health plans sold on the Connector. The issuer fee begins January 1, 2014 for the individual market, and July 1, 2014 for the SHOP.

Iowa

State federal partnership

Idaho

Domain	State Approach	Details
Exchange establishment date and type	Your Health Idaho (March 2013)	House bill 248
Governance	Quasi-governmental	A non-profit independent body that is not a state agency.
Board Membership	19 member board; 17 voting members	17 voting members: Three members representing individual consumer interests: Stephen Weeg, retired executive director of Health West Mark Estess, Idaho director of AARP Karen Vauk, president and CEO of the Idaho Food Bank Three members representing different health carriers: Dave Self, senior vice president and regional director for Pacific Source Scott Kreiling, president of Regence Blue Shield of Idaho Zelda Geyer-Sylvia, president and CEO of Blue Cross of Idaho Two members representing producers: B. Hyatt Erstad, Erstad and Co. Tom Shores, Shores Insurance Four members representing small employer business: TBD Jeff Agenbroad, owner, Since 86, Inc. Kevin Settles, owner, Bardenay Restaurant and Distillery, Eagle and Coeur d’Alene Fernando Veloz, MS Administrative Services, chairman of the Employers Health Coalition of Idaho Two members representing health care providers: John Livingston, M.D. Margaret Henbest, R.N. Three legislative members: Senator Jim Rice Representative Kelley Packer Representative John Rusche Two non-voting members: Bill Deal, Idaho Department of Insurance Director Richard Armstrong, Idaho Department of Health and Welfare Director
Board Conflict of Interest Requirement	Yes	A majority of the board shall not collectively represent health carriers and producers. When a conflict of interest arises, it will be fully disclosed ot the board and the board member will abstain from any vote on the matter and comply with any addtional requirements established pursuant to the plan of operation for the marketplace.
Approach to Health Plan Selection	Clearinghouse	Allows all plans meeting minimum criteria to participate on the exchange; does not selectively contract with insurers or manage plan choices.
Insurer Participation Requirement	No
Coverage Level Requirements	Requires a minimum of two levels of coverage	Complies with reform law requirement that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	No
Health Plans to Display Quality Data in 2014	No	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	No	A single plan is offered.
Consumer Assistance	In-person assisters	Program is aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Assessment on insurers offering coverage in the individual and small-group markets

Illinois

State federal partnership

Indiana

Federally facilitated marketplace

Kansas

Federally facilitated marketplace

Kentucky

Domain	State Approach	Details
Exchange Establishment	kynect (July 17, 2012)	Executive order 2012-587
Governance	Existing state agency	The Office of the Kentucky Health Benefit Exchange is created within the Cabinet for Health and Family Services. The executive order also creates four divisions within the office: the Division of Health Care Policy Administration; the Division of Information Systems; the Division of Financial and Operations Administration; and the Division of Communication and Outreach. Carrie Banahanh has been appointed as executive director.
Board Membership	11-member Exchange Advisory Board	The governor makes appointments to the advisory board. The advisory board will include: The commissioners (or their designees) of the Department of Medicaid Services, the Department of Insurance, and the Department of Behavioral Health and Developmental and Intellectual Disabilities; A representative of state- licensed insurance agents; A representative for state-licensed non-facility based health care providers; A representative for state-licensed facility based health care providers; A state-based small employer representative; A representative of an individual purchaser of state health plans; Two consumer representatives.
Board Conflict of Interest Requirement	Yes	As a state agency, the exchange must adhere to Kentucky's Open Records Act, Open Meeting Law, Model Procurement Code, and the Kentucky Executive Branch Code of Ethics. All these statutes ensure conflict of interest standards as well as accountability and transparency standards.
Approach to Health Plan Selection	Market organizer	Manages plan choices through limits on the number or type of plans that an insurer can offer but does not selectively contract with insurers.
Insurer Participation Requirement	No
Coverage Level Requirements	Requires a minimum of three levels of coverage	Insurers in the exchange must offer at least catastrophic, silver, and gold coverage. Reform law requires that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Limits the number of plans per insurer
Health Plans to Display Quality Data in 2014	No	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees a single plan or a choice of multiple insurers in one tier, or multiple insurers in multiple tiers. Employers are limited to choosing plans on small-business exchange on tiers that are contiguous (i.e., the employer may not select only the bronze and gold levels for employees).
Consumer Assistance	In-person assistance program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Undecided

Louisiana

Federally facilitated marketplace

Massachusetts

Domain	State Approach	Details
Exchange Establishment	Health Connector (2006)	Chapter 58 of Acts 2006; Chapter 176Q
Governance	Quasi-governmental
Board Membership	11-member board	Board includes four ex-officio members, four members appointed by governor (actuary, health economist, underwriter, and small business representative); and three members appointed by attorney general (employee health benefits specialist, consumer representative, organized labor represenative): Glen Schor, ex-officio, Chair, Secretary of the Executive Office for Administration and Finance Ian Duncan, Founder and President of Solucia Inc. George Gonser Jr., CEO of Spring Insurance Group LLC Jonathan Gruber, Professor of Economics at the Massachusetts Institute of Technology Julian Harris, M.D., ex-officio, Medicaid Director Andrés López, Principal of AJL Consultants Louis Malzone, Executive Director, Massachusetts Coalition of Taft-Hartley Funds Dolores Mitchell, ex-officio, Executive Director, Group Insurance Commission Joseph G. Murphy, ex-officio, Commissioner, Division of Insurance Nancy Turnbull, Senior Lecturer on Health Policy and Associate Dean for Educational Programs, Harvard School of Public Health Celia Wcislo, Assistant Division Director and Vice President At-Large, 1199SEIU United Healthcare Workers East Executive Director: Jean Yang
Board Conflict of Interest Requirement	Yes	Board members may not be employees of any licensed carrier authorized to do business in the Commonwealth.
Approach to Health Plan Selection	Selective contractor	Contracts only with insurers that advance exchange goals and may manage plan choices through limits on the number or type of plans that an insurer can offer.
Insurer Participation Requirement	Requires insurers to participate in the exchange	State requires certain insurers that offer coverage in the individual or small-group markets to participate in the exchange or submit a bid to participate in the exchange.
Coverage Level Requirements	Requires a minimum of five levels of coverage	Insurers in the exchange must propose or offer all five coverage levels: catastrophic, bronze, silver, gold, and platinum coverage. Federal law requires that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Limits the number of plans per insurer, requires some standardized plans, and adopts a meaningful difference standard (health plan choices must be distinctly different from one another).
Health Plans to Display Quality Data in 2014	Yes	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer their employees a single plan or a choice of multiple insurers in one tier, or one insurer in multiple tiers.
Consumer Assistance	Navigator program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Undecided

Maryland

Domain	State Approach	Details
Exchange Establishment	Maryland Health Connection (April 12, 2011)	Senate Bill 182
Governance	Quasi-governmental	Must decide on or before December 1, 2015 if the exchange will become a nongovernmental, nonprofit entity. Until that time, the exchange should not take any action that would prohibit such a change.
Board Membership	Nine-member board	Six members will be appointed by the governor with advice/consent of the Senate. These board members are: Darrell Gaskin, Johns Hopkins Bloomberg School of Health Georges Benjamin, American Public Health Association Jennifer Goldberg, Maryland Legal Aid Bureau Enrique Martinez-Vidal, AcademyHealth and Robert Wood Johnson Foundation Thomas Saquella, Maryland Retailers Association Kenneth S. Apfel, University of Maryland, School of Public Policy The three additional board members are: the Secretary of Health and Mental Hygiene (Joshua M. Sharfstein), the Insurance Commissioner (Therese Goldsmith), and the Executive Director of the Maryland Health Care Commission (Ben Steffen) Executive Director: Rebecca Pearce
Board Conflict of Interest Requirement	Yes	Board members may not participate in activities that are financially beneficial to themselves or family members. Board members must adhere to all state ethics and conflict of interest laws. Individuals who are employees or representatives of insurance carriers, brokers or agents, or health care facilities may not be board members or exchange employees. Board members and exchange employees may be health care providers if they are not compensated for the health care services rendered and have no ownership interest in a professional practice.
Approach to Health Plan Selection	Market organizer	Manages plan choices through limits on the number or type of plans that an insurer can offer but does not selectively contract with insurers.
Insurer Participation Requirement	Requires insurers to participate in the exchange	State requires certain insurers that offer coverage in the individual or small-group markets to participate in the exchange or submit a bid to participate in the exchange.
Coverage Level Requirements	Requires a minimum of three levels of coverage	Insurers in the exchange must offer at least bronze, silver, and gold coverage. Federal law requires that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Limits the number of plans per insurer
Health Plans to Display Quality Data in 2014	Yes	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees choice of multiple insurers in one tier, or one insurer in multiple tiers.
Consumer Assistance	Navigator and in-person assistance program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Will use existing state assessment or premium tax

Maine

Federally facilitated marketplace

Michigan

State federal partnership

Minnesota

Domain	State Approach	Details
Exchange establishment date and type	MNsure (March 2013)	House bill 5
Governance	Quasi-governmental	State agency in executive branch.
Board Membership	Seven member board	Governor/Commissioner of Human Services will appoint six board members: One member that represents the interests of small employers: Brian Beutner, Chair One member representing the areas of health administration, health care finance, health plan purchasing, and health care delivery systems : Peter Benner, Vice Chair One member that represents the interests of individual consumers eligible for the individual market: Thompson Aderinkomi One representing the areas of public health, health disparities, income based public health care programs, and the uninsured: Kathryn Duevel, M.D. One member representing health policy issues related to small group and individual markets: Tom Forsythe, Vice President Global Communications, General Mills One member that represents the interests of individual consumers eligible for income based public health care program: Phil Norrgard, Director of Human Services, Fond du Lac Band of Lake Superior Chippewa Lucinda Jesson, Commissioner of the Minnesota Department of Human Services
Board Conflict of Interest Requirement	Yes	Board members must comply with Minnesota statutes for disclosure of conflict of interest and for disclosure of gifts from lobbyists. Over the course of a board member's term and for the year preceding their term, members appointed by the governor shall not be employed by, be a member of the board of, or otherwise be a representative of a health carrier, institutional health care provider, or other entity providing health care, navigator, insurance producer, or other entity in the business of selling items or services of significant value to or through the marketplace. No member can serve as a lobbyist. Directors must recuse themselves from discussion of and voting on an official matter if the director has a conflict of interest. Board members may be compensated according to state statute regarding administrative boards ($55/day)
Approach to Health Plan Selection	Clearinghouse	Allows all plans meeting minimum criteria to participate on the exchange; does not selectively contract with insurers or manage plan choices.
Insurer Participation Requirement	No
Coverage Level Requirements	Requires a minimum of two levels of coverage	Complies with reform law requirement that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	No
Health Plans to Display Quality Data in 2014	No	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employees can offer their employees a choice of multiple insurers in one tier, one insurer in multiple tiers, multiple insurers in multiple tiers, or all insurers in all tiers.
Consumer Assistance	Navigator program and in-person assistance program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Assessment on insurers offering coverage in the individual and small-group markets

Missouri

Federally facilitated marketplace

Mississippi

Federally facilitated marketplace

Montana

Federally facilitated marketplace

North Carolina

Federally facilitated marketplace

North Dakota

Federally facilitated marketplace

Nebraska

Federally facilitated marketplace

New Hampshire

State federal partnership

New Jersey

Federally facilitated marketplace

New Mexico

Domain	State Approach	Details
Exchange establishment date and type	BeWell NM (March 28, 2013)	Senate bill 221
Governance	Quasi-governmental	Considered a governmental entity only for purposes of the Tort Claims Act.
Board Membership	13 voting members	Board members: James R. Damron, M.D., (Chair), University of New Mexico School of Medicine Jason Sandel (Vice Chair), New Mexico Medical Insurance Pool Terriane Everhart, Property Consultants John Franchini, New Mexico Superintendent of Insurance Teresa Gomez, Futures for Children Martin Hickey, M.D., New Mexico Health Connections Larry Leaming, M.D., Roosevelt General Hospital Gabriel Parra, Presbyterian Healthcare Services Patsy Romero, Easter Seals El Mirador David Shaw, Nor-Lea General Hospital Ben Slocum, Lovelace Health Plan Sidonie Squier, Secretary, New Mexico Human Services Department J. Deane Waldman, M.D., University of New Mexico Health Sciences Center The Board shall be composed, as a whole, to assure representation of the state's Native American population, ethnic diversity, cultural diversity, and geographic diversity.
Board Conflict of Interest Requirement	Yes	All exchange staff and directors are subject to the Governmental Conduct Act and shall not have any affiliation with any health care provider, health insurance issuer, or health care service provider. The following exceptions are allowed: directors from the New Mexico medical insurance pool boards of directors health insurance alliance shall not be considered to have a conflict of interest with respect to their association with those entities; the secretary of human services shall not be considered to have conflict of interest with respect to the secretary's duties as secretary of human services; the director who is a health care provider shall not be considered to have a conflict of interest from having received payment for services as a provider; and the directors who are representatives of health insurance issuers shall not be considered to have a conflict of interest with respect to their association with their respective health insurance issuers.
Approach to Health Plan Selection	Clearinghouse	Allows all plans meeting minimum criteria to participate on the exchange; does not selectively contract with insurers or manage plan choices.
Insurer Participation Requirement	Encourages insurers to participate in the exchange	State prohibits an insurer from entering the exchange for up to two years if the insurer does not participate in 2014.
Coverage Level Requirements	Requires a minimum of two levels of coverage	Complies with reform law requirement that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	No
Health Plans to Display Quality Data in 2014	Will begin in 2015	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer their employees a choice from multiple insurers in one tier.
Consumer Assistance	Navigator and in-person assistance programs	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Undecided

Nevada

Domain	State Approach	Details
Exchange Establishment	Nevada Health Link (June 16, 2011)	Senate Bill 440
Governance	New state agency
Board Membership	10-member board	Seven voting members, Seven voting members: five appointed by governor, one by State Senate Majority Leader, and one by State Speaker of the Assembly. The voting members are: Barbara Smith Campbell, Principal of Consensus LLC Lynn Etkins, Development Director for Legal Aid Center of Southern Nevada Judith P. Ford, health care provider Leslie A. Johnstone, Executive Director, Health Services Coalition Marie Martin Kerr, partner, Kerr IP Group, LLC Florence Jamison, health care provider E. Lavonne Lewis, Interim President and CEO, Las Vegas Clark County Urban League Three nonvoting members: Mike Willden, Director, State Department of Health and Human Services Scott Kipper, Commissioner, Nevada Division of Insurance Jeff Mohlenkamp, Director, State Department of Administration Members may not be legislators or hold any elective office in state government. Executive Director: Jon Hager
Board Conflict of Interest Requirement	Yes	Board members may not in any way be affiliated with health insurers, including serving on boards of health insurers, being a consultant to a health insurer, or having any ownership interest in a health insurer.
Approach to Health Plan Selection	Market Organizer	Manages plan choices through limits on the number or type of plans that an insurer can offer but does not selectively contract with insurers.
Insurer Participation Requirement	No
Coverage Level Requirements	Requires a minimum of two levels of coverage	Complies with reform law requirement that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Limits the number of plans per insurer, and adopts a meaningful difference standard (health plan choices must be distinctly different from one another).
Health Plans to Display Quality Data in 2014	To be determined	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer their employees a choice from multiple insurers in one tier, or one insurer in multiple tiers.
Consumer Assistance	Navigator and in-person assistance programs	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Assessment on insurers offering coverage in the individual and small-group markets

New York

Domain	State Approach	Details
Exchange Establishment	New York State of Health (April 12, 2012)	Executive Order #42
Governance	Existing state agency	Established within the New York Department of Health
Board Membership	Not addressed	Not addressed
Board Conflict of Interest Requirement	Not addressed	Not addressed
Approach to Health Plan Selection	Market organizer	Manages plan choices through limits on the number or type of plans that an insurer can offer but does not selectively contract with insurers.
Insurer Participation Requirement	Encourages insurers to participate in the exchange	State prohibits an insurer from entering the exchange for up to two years if the insurer does not participate in 2014.
Coverage Level Requirements	Requires a minimum of five levels of coverage	Insurers in the exchange must propose or offer all five coverage levels: catastrophic, bronze, silver, gold, and platinum coverage. Federal law requires that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Limits the number of plans per insurer, and requires some standardized plans.
Health Plans to Display Quality Data in 2014	Yes	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees a single plan or choice of multiple insurers in one tier, one insurer in multiple tiers, multiple insurers in multiple tiers, or all insurers in all tiers.
Consumer Assistance	Navigator and in-person assistance program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Undecided

Ohio

Federally facilitated marketplace

Oklahoma

Federally facilitated marketplace

Oregon

Domain	State Approach	Details
Exchange Establishment	Cover Oregon (June 7, 2011)	Senate Bill 99
Governance	Quasi-governmental
Board Membership	Nine-member board, all with voting rights	Board includes: Liz Baxter (Chair), Executive Director, Oregon Public Health Institute Teri Andrews (Vice Chair), Owner, CG Industries Dr. Bruce Goldberg, Director, Oregon Health Authority Laura Cali, Insurance Commissioner, Insurance Division, Oregon Department of Consumer and Business Services Ken Allen, Executive Director, Oregon AFSCME Council 75 Aelea Christofferson, Owner, ATL Communications Jose Gonzales, Principal Broker, Tu Casa Real Estate Corporation Gretchen Peterson, Vice President of Human Resources, Hanna Andersson Dr. George Brown, Chief Executive Officer, Legacy Health System
Board Conflict of Interest Requirement	Yes	If a member has a conflict of interest regarding an issue before the exchange that would result in the member or a member’s family receiving a financial benefit, the conflict will be recorded and the member may still participate in the discussion but cannot vote on the issue. No more than two governor-appointed board members and no exchange staff may be affiliated with an insurer, third party administrators, insurance producer or broker, provider, or trade association. Board members and exchange employees may be health care providers if they are not compensated for the health care services rendered and have no ownership interest in a professional practice.
Approach to Health Plan Selection	Market Organizer	Manages plan choices through limits on the number or type of plans that an insurer can offer but does not selectively contract with insurers.
Insurer Participation Requirement	Encourages insurers to participate in the exchange	State prohibits an insurer from entering the exchange for up to two years if the insurer does not participate in 2014.
Coverage Level Requirements	Requires a minimum of three levels of coverage	Insurers in the exchange must offer at least bronze, silver, and gold coverage. Federal law requires that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Limits the number of plans per insurer, and requires some standardized plans.
Health Plans to Display Quality Data in 2014	Yes	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees a single plan or choice of multiple insurers in one tier, or one insurer in multiple tiers, or multiple insurers in multiple tiers, or all insurers in all tiers. Choosing from all insurers in all tiers is only available if the employer chooses a gold plan as the reference plan.
Consumer Assistance	Navigator and in-person assistance program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Assessment on insurers offering coverage in the individual and small-group markets

Pennsylvania

Federally facilitated marketplace

Rhode Island

Domain	State Approach	Details
Exchange Establishment	Rhode Island: HealthSource RI (September 9, 2011)	Executive Order 11-09
Governance	Existing state agency	Established within Executive Department
Board Membership	13-member board	Three board members will include: Director of Department of Administration (Richard Licht) Health Insurance Commissioner (Kathleen Hittner, MD) Secretary of the Executive Office of Health and Human Services (Steven Costantino) Department of Health Representative (Amy Zimmerman) The nine members appointed by governor are: Margaret Curran (Chair), former United States Attorney for Rhode Island Geoffry Grove (Vice-Chair), Pilgrim Screw Corporation Michael C. Gerhardt, Save The Bay and former health insurance executive Margaret Holland McDuff, Family Service of Rhode Island Peter Howland, M.D., Retired pediatrician Linda Katz, The Economics Progress Institute Marta Martinez, Progresso Latino Dwight McMillan, The Basics Group Tim Melia, UFCW New England Council Executive Director: Christine Ferguson
Board Conflict of Interest Requirement	Yes	Board members may not participate in activities that are financially beneficial to themselves or family members. Board membership and exchange staff may not include individuals who are employees or representatives of insurance carriers, brokers or agents, or health care facilities Board members and exchange employees may be health care providers if they are not compensated for the health care services rendered and have no ownership interested in a professional practice. No board member may receive compensation.
Approach to Health Plan Selection	Selective contractor	Contracts only with insurers that advance exchange goals and may manage plan choices through limits on the number or type of plans that an insurer can offer.
Insurer Participation Requirement	No
Coverage Level Requirements	Requires a minimum of two levels of coverage	Complies with reform law requirement that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	No
Health Plans to Display Quality Data in 2014	Yes	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees a single plan, or choice of all insurers in all tiers.
Consumer Assistance	Navigator and in-person assistance program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Undecided

South Carolina

Federally facilitated marketplace

South Dakota

Federally facilitated marketplace, conducting plan management

Tennessee

Federally facilitated marketplace

Texas

Federally facilitated marketplace

Utah

Domain	State Approach	Details
Exchange Establishment	Avenue H (2008)	HB 188 (2009); HB 133 (2008) For small businesses only
Governance	Existing state agency	Office of Consumer Health Services within the Governor’s Office of Economic Development
Board Membership	Executive steering committee and a risk adjuster board for the marketplace's defined contribution market	The exchange is governed by two boards: the Executive Steering Committee and the Defined Contribution Risk Adjuster Board. Executive Steering Committee: Spencer Cox (Co-Chair), Lt. Governor Greg Poulsen (Co-Chair), Intermountain Healthcare Marc Bennett, HealthInsight Rich McKeown, Salt Lake Chamber’s Health Committee & Leavitt Partners Gordon Crabtree, University of Utah Pam Gold, United HealthCare Pat Richards, SelectHealth Jennifer Cannaday, Regence BlueCross/BlueShield Howard Headlee, Utah Bankers Association David Patton, Department of Health Mark Van Orden, Department of Technology Services Spencer Eccles, Governor’s Office of Economic Development Colleen Mellor, Strategic Employee Benefit Services Todd Kiser, Department of Insurance Greg Matis, SelectHealth Vaughn Holbrook, Regence Blue Cross Blue Shield Ernie Sweat, Fringe Benefit Analysts Patty Conner, Avenue H, Office of Consumer Health Services Norm Thurston, Office of Consumer Health Services Defined Contribution Risk Adjuster Board: Dave Jackson (Chair), First West Benefit Solution Jim Murray, SelectHealth Kim Miller, United Health Care Norman Thurston, Office of Consumer Health Services Tomasz Serbinowski, Utah Health Insurance Department Paul Anderton, Public Employees Health Plan
Board Conflict of Interest Requirement	Not addressed	Not addressed
Approach to Health Plan Selection	Clearinghouse	Allows all plans meeting minimum criteria to participate on the exchange; does not selectively contract with insurers or manage plan choices.
Insurer Participation Requirement	No
Coverage Level Requirements	Requires a minimum of two levels of coverage	Complies with reform law requirement that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Adopts a meaningful difference standard (health plan choices must be distinctly differenct from one another)
Health Plans to Display Quality Data in 2014	No	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees choice of multiple insurers in one tier, or from all insurers in all tiers.
Consumer Assistance	Navigator program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Will use existing state assessment or premium tax

Virginia

Federally facilitated marketplace

Vermont

Domain	State Approach	Details
Exchange Establishment	Vermont Health Connect (June 26, 2011)	Public Act No. 48
Governance	Existing state agency	Established as a division within the Department of Vermont Health Access
Board Membership	Exchange administered by Department of Vermont Health Access	Deputy Commissioner of Vermont Health Access Department will work in consultation with Vermont Medicaid and Exchange Advisory Committee to administer the exchange. Medicaid and Exchange Advisory Board Members: Bram Kleppner, Danforth Pewter (co-chair) Catherine Hamilton, Blue Cross Blue Shield of Vermont Cathy Davis, Lake Champlain Regional Chamber of Commerce Christina Colombe, consumer representative Clifton Long, consumer representative Dale Hackett, consumer representative Donna Sutton Fay, Vermont Campaign for Health Care Security Ellen Gershun, consumer representative Floyd Nease, Vermont Association for Mental Health and Addiction Recovery Gladys Mooney, consumer representative Harry Chen, Commissioner of Vermont Department of Health Joan Lavoie, consumer representative Julie Lineberger, LineSync Architecture Julie Tessler, Vermont Council of Developmental and Mental Health Services Kay Van Woert, Vermont Family Network (co-chair) Larry Goetschius, Addison County Home Health & Hospice Laura Pelosi, Vermont Health Care Association Lisa Maynes, consumer representative Liz Cote, Vermont State Dental Society Madeleine Mongan, Vermont Medical Society Michael Sirotkin, Community of Vermont Elders Paul Bakeman, Vermont Coalition for Disability Rights Randy Cook, Fletcher Allen Health Care Shannon Wilson, Vermont Chamber of Commerce Sharon Henault, consumer representative Sheila Reed, Voices for Vermont’s Children Susan Barrett, Bi‐State Primary Care Association Tim Ford, Vermont Independent Agents Association Trinka Kerr, Vermont Health Care Ombudsman
Board Conflict of Interest Requirement	Not applicable	Not applicable
Approach to Health Plan Selection	Selective contractor	Contracts only with insurers that advance exchange goals and may manage plan choices through limits on the number or type of plans that an insurer can offer.
Insurer Participation Requirement	Requires insurers to participate in the exchange	State established a single marketplace where all individual and small-group coverage must be sold through the exchange.
Coverage Level Requirements	Requires a minimum of four levels of coverage	Insurers in the exchange must offer at least bronze, silver, gold, and platinum coverage. Federal law requires that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	Yes	Limits the number of plans per insurer, requires some standardized plans, and adopts a meaningful difference standard (health plan choices must be distinctly different from one another).
Health Plans to Display Quality Data in 2014	No	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees choice of multiple insurers in one tier, or all insurers in all tiers.
Consumer Assistance	Navigator and in-person assistance program	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Yes	Will use existing state assessment or premium tax

Washington

Domain	State Approach	Details
Exchange Establishment	Washington Healthplanfinder (May 26, 2011)	Senate Bill 5445 The exchange board, the Washington State Health Care Authority, and the legislature’s Joint Select Committee on Health Reform Implementation must collaborate to make recommendations to the governor on a broad range of exchange options including whether and under what circumstances the state should establish or participate in a regional/multistate exchange.
Governance	Quasi-governmental	A legislatively chartered corporation constituting a public–private partnership, separate and distinct from the state, subject to state open public meeting and public records acts but no other laws generally applicable to state agencies. Operates in collaboration with the Joint Committee on Health Reform Implementation.
Board Membership	11-member board: eight voting members, two nonvoting, one nonvoting except in case of a tie (chair)	Eight voting members and the chair have been appointed by governor: Margaret Stanley (Chair), formerly with Puget Sound Health Alliance and Regence Blue Shield Steve Appel, farmer, formerly with Washington Farm Bureau Bill Baldwin, The Partners Group Don Conant, Valley Nut and Bolt and School of Business at St. Martin’s University Doug Conrad, University of Washington School of Public Health Melanie Curtice, Stoel Rives LLP Ben Danielson, Odessa Brown Children’s Clinic Phil Dyer, Kibble & Prentice/USI and former state legislator Teresa Mosqueda, Washington State Labor Council and Healthy Washington Coalition Nonvoting members: Mike Kreidler, Washington State Insurance Commissioner Dorothy Teeter, Director of Health Care Authority CEO: Richard Onizuka
Board Conflict of Interest Requirement	Yes	Board members may not be appointed if service would financially benefit the member or any entity the member represents. A member shall resign or be removed if such a conflict develops over the member’s tenure.
Approach to Health Plan Selection	Clearinghouse	Allows all plans meeting minimum criteria to participate on the exchange; does not selectively contract with insurers or manage plan choices.
Insurer Participation Requirement	No
Coverage Level Requirements	Requires a minimum of two levels of coverage	Complies with reform law requirement that insurers offer at least two coverage levels: silver and gold.
Efforts to Simplify Consumer Choice	No
Health Plans to Display Quality Data in 2014	Will begin in 2015	Federal requirement begins in 2016
Health Plan Choice for Small Businesses	Yes	Employers can offer employees a single plan or choice of multiple insurers in one tier.
Consumer Assistance	Navigator and in-person assistance programs	Programs are aimed at informing public about the exchanges and providing assistance to consumers in selecting health plans.
Revenue Raisers	Tax and Assessment	2% tax on gross premiums and potential assessments beginning 2015

Wisconsin

Federally facilitated marketplace

West Virginia

State federal partnership

Wyoming

Federally facilitated marketplace

Legend

Alaska

Alabama

Arkansas

Arizona

California

Colorado

Connecticut

District of Columbia

Delaware

Florida

Georgia

Hawaii

Iowa

Idaho

Illinois

Indiana

Kansas

Kentucky

Louisiana

Massachusetts

Maryland

Maine

Michigan

Minnesota

Missouri

Mississippi

Montana

North Carolina

North Dakota

Nebraska

New Hampshire

New Jersey

New Mexico

Nevada

New York

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Virginia

Vermont

Washington

Wisconsin

West Virginia

Wyoming

Mission

Recent Tweets

The Commonwealth Fund