State Health Insurance Exchanges: Progress and Challenges


  • Sara R. Collins,

  • Tracy Garber

  • Sara R. Collins is vice president and Tracy Garber is senior policy associate for affordable health insurance at The Commonwealth Fund.


By 2014, each of the fifty states and the District of Columbia will have a new health insurance exchange, or marketplace, established under the Patient Protection and Affordable Care Act. These exchanges are the centerpiece of the reform law: they will be the main portals where people who do not have health insurance coverage through their jobs and small businesses will go, either in person or online, to find a health plan and to learn about and apply for federal subsidies. The most immediate challenge facing all fifty-one exchanges is fulfilling their most basic role: ensuring that all who are eligible to enroll in qualified health plans and to receive federal subsidies in fact enroll.