State of the nation's health insurance exchanges

Health insurance exchanges, or marketplaces, are a key component of the Affordable Care Act and the places where individuals and small businesses will be able to shop for affordable health coverage. As of February 2013, 17 states and the District of Columbia opted to establish a state-based exchange, 7 states were planning for a partnership exchange, and 26 states defaulted to a federal exchange. The authors will provide an overview of the state of the nation's exchanges, assessing early successes and failures during the open enrollment period and comparing the experiences of state-based exchanges to partnership exchanges and the federal exchange. The authors will also examine public opinion in support of exchanges and how that relates to decisions of elected officials. Looking ahead, the authors will discuss the opportunities exchanges provide for addressing public health priorities and improving population health, as well as the challenges to successful implementation of these goals.