Health Insurance Exchanges

Overview HCAN’s Work More Resources


A health insurance exchange is a new marketplace for buying insurance. In 2014, every state will have an exchange that will organize plans and make them transparent so you know what benefits are covered and at what cost. In addition, middle-income families (less than $92,000 for a family of 4) without another source of insurance may be eligible for tax credits to help pay the cost of coverage.Retiree with Health Care Sign

HCAN fact sheet: What is a health insurance exchange?

HCAN’s Work on Health Insurance Exchanges

We organize at the grassroots around all of our priority issues in order to move policymakers and build public support. Our work on Capitol Hill is also key to our effort; please see below for examples of that work and relevant documents.

Key Issues in Exchanges
The federal rules for state exchange establishment and eligibility are expected to be finalized in the spring of 2012.

Proposed federal rule on the establishment of Exchanges

HCAN’s comments on Exchange establishment

Proposed federal rule on determining eligibility for the Exchanges

HCAN’s comments on Exchange eligibility

One of the most important issues to be decided in the states is who will govern the Exchanges. The governing board will have the ability to direct all the future decisions of the Exchanges. HCAN and our state partners urge states to establish governing boards with strong consumer representation and to prohibit the participation of anyone who will benefit financially from the decisions of the Exchange, like representatives of insurance companies or insurance agents and brokers.

HCAN fact sheet: Avoiding conflicts of interest in health insurance exchanges

HCAN and consumer letter to HHS on conflict of interest provisions

Federally-Facilitated Exchanges
States that do not have a fully-operational exchange may enter into a Partnership with the Department of Health and Human Services to perform either the consumer support or plan management functions while HHS retains ultimate responsibility for Exchange implementation.

HCAN’s comments on General Guidance on Federally-Facilitated

Exchanges Should Work For Consumers, Not Insurance Companies
Exchanges should be smart purchasers with the authority to leverage the millions of consumers purchasing coverage there to command the best prices for consumers. But many states want to tie the hands of the Exchanges and force them to except every health plan that meets minimum standards. HCAN supports a dynamic Exchange that works on behalf of consumers to cut the fat from health insurance premiums and get the best prices.

HCAN fact sheet: How your state can put families, businesses and taxpayers first

State Progress
Each state must have an Exchange ready to offer coverage by January 1, 2014. HHS will evaluate states’ progress in January 2013 and begin to set-up a federally-facilitated Exchange for states that aren’t on target to meet the 2014 deadline.

To date, 13 states and the District of Columbia have passed a law or have executive authority to establish an Exchange:

  • California
  • Colorado
  • Connecticut
  • Washington, D.C.
  • Hawaii
  • Maryland
  • Massachusetts
  • Nevada
  • Oregon
  • Rhode Island
  • Utah
  • Vermont
  • Washington
  • West Virginia

In September 2010, 48 states and DC were awarded $1 million grants to begin Exchange planning. In 2011, 28 states and DC received additional funding to support their progress in planning and implementing Exchanges.

HCAN and dozens of consumer groups sent a letter to Congress opposing attempt to block funding for exchange (5/2/11)

More Resources

In addition to the many fact sheets and other resources linked above, find other resources here: