By January 2014, every state will have a health insurance exchange where people can buy health insurance plans and apply for subsidies to help make those plans affordable. The Affordable Care Act gives states the option of establishing their own health insurance exchanges, or letting the Department of Health and Human Services (HHS) operate a "federally facilitated" exchange in their state. HHS is also giving states the option to run their exchange in partnership with the federal government. In an updated blog post, The Commonwealth Fund's Sara R. Collins, Ph.D., and Tracy Garber report on the status of each exchange, including plans that received conditional approval last week. Also see our interactive map on state exchange activity.