Delivering the promise of health reform to women: An assessment of state progress in developing woman-friendly state health exchanges

State health insurance exchanges are supposed to offer quality, affordable health coverage to individuals and small businesses beginning in 2014. While not all states are moving forward rapidly to create exchanges, and some are outright resisting doing so, as of February 2012, 11 states had already officially created exchanges and more will be moving to do so in the coming year. But, as these exchanges are being developed, advocates for women's health and public health must guard against the introduction of policies that would restrict reproductive health coverage, discriminate against LGBTQ people, poorly serve immigrants or fail to adequately address health disparities. The authors will present a "watch list" of critical issues for advocates to monitor and influence as state exchanges are being developed. These issues include: exchange leadership and governance to ensure transparent operations with adequate public input and without undue influence by insurance companies and regressive politicians; consumer assistance programs that help people choose health coverage that meets their needs and fits their budgets; provider network adequacy to ensure that the exchanges include enough reproductive health providers, community health centers, providers who can serve LGBTQ people and providers who speak languages other than English; coverage benefits that include women's health and LGBTQ health needs; and potential service restrictions or policies that would allow providers to refuse to deliver certain services or treat certain patients. The authors will provide examples of how state-based advocates have countered negative proposed policies and help establish positive policies.