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Health Insurance Exchange Decisions by State

Author: Tracy Morley, XpertHR Legal Editor

Through the creation of state-based health insurance exchanges, the Affordable Care Act (ACA) creates a competitive marketplace from which individuals and small businesses may purchase affordable health insurance. Coverage through the exchanges started January 1, 2014.

Every state and the District of Columbia is required to have an exchange. States that did not establish an exchange have a federally facilitated exchange operated by the US Department of Health and Human Services. A state could have also chosen to operate an exchange in partnership with the federal government or have a state-based exchange operated on the federal platform.

The following chart identifies state decisions for creating health care exchanges.