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State Health Insurance Exchange Laws: The First Generation


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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.

Publication Details

Publication Date: July 25, 2012
Author: Sara Rosenbaum, Nancy Lopez, J.D., M.P.H., Taylor Burke, J.D., L.L.M., and Mark Dorley, M.P.H.

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


Harold and Jane Hirsh Professor of Health Law and Policy, Milken Institute School of Public Health at the George Washington University