Health Reform: Designing a Marketplace
A state-by-state comparison of Marketplace Implementation

Table of Contents

(click here to view the detailed full list of Marketplace design questions)

The Affordable Care Act (ACA) creates a Health Insurance Marketplace (Marketplace) in every state, which offers individuals and small businesses the opportunity to shop from an array of affordable, comprehensive health insurance plans.  A state can either create and operate the Marketplace itself as a State-based Marketplace (SBM), partner with the federal government under a State Partnership Marketplace (SPM), or defer to the U.S. Department of Health and Human Services to manage a Federally-facilitated Marketplace (FFM) in the state.

In 2014, 16 states and the District of Columbia have established a State-based Marketplace for both individuals and small businesses, six states have a State Partnership Marketplace, and one state is administering a State-based SHOP Marketplace just for small businesses (with an FFM serving individuals).

The ACA provides states with significant flexibility in the design and structure of their Marketplace; hundreds of policy and operational decisions had to be addressed during the Marketplace implementation process.  CBPP has evaluated SBM and SPM states across a number of these Marketplace design questions and compiled the information in this interactive tool.

How to use this tool

Marketplace design information available for each state is displayed in the online database.  Users may first wish to explore the entire list of questions via the link provided in the Table of Contents before navigating the database to become familiar with the various Marketplace design measures.  A version of the Table of Contents is also provided in the left-hand tab on the database page which allows users to jump to a specific design question in any category.  Scrolling to the right or left allows you to compare responses to a specific design question across all states, or you can select a particular state from the drop-down menu and compare its responses to all other states.  Users can also download the data into an Excel spreadsheet.  Unless otherwise indicated, all information applies to the 2014 plan year.

Note: this resource will be updated periodically to reflect new information as it becomes available.  If information appears out-of-date or inaccurate for a given state, please contact Dave Chandra, chandra@cbpp.org.

Sources

Information on State-based Marketplaces and State Partnership Marketplaces was obtained from the following sources:

  • State-based Marketplace Board meeting notes and minutes;
  • Public resources and materials available online from State-based Marketplaces and State Partnership Marketplaces;
  • The Center on Health Insurance Reform, Georgetown University Health Policy Institute;
  • The Commonwealth Foundation;
  • Kaiser Family Foundation;
  • State Health Reform Assistance Network (SHRAN);
  • KidsWell;
  • Conversations with health care advocacy organizations in State-based Marketplace and State Partnership Marketplace states; and
  • Conversations with representatives of the Marketplace, Department of Insurance, Department of Health, Medicaid agency, or Governor’s Office in State-based Marketplace and State Partnership Marketplace states.

Acknowledgements

We would like to thank the following agencies and individuals for their assistance in reviewing and verifying our Marketplace findings for their states:

Arkansas Insurance Department
Delaware Department of Health and Social Services
Connect for Health Colorado
Cover Oregon
Covered California
HealthSource RI
Maryland Health Connection
Massachusetts Health Connector
MNsure
Nevada Health Link
New Mexico Health Insurance Exchange
Utah Governor’s Office of Economic Development
Vermont Health Connect
West Virginia Office of the Insurance Commissioner

Ellen Andrews, Connecticut Health Policy (Connecticut)
Elisabeth R. Benjamin, Community Service Society of New York (New York)
Kyle Brittingham, Community Service Society of New York (New York)
Suzanne Curry, Health Care for All (Massachusetts)
Jim Duffett, Campaign for Better Healthcare (Illinois)
Lynn Etkins, Legal Aid Center of Southern Nevada (Nevada)
Sarah Greenfield, Take Action Minnesota (Minnesota)
Debra Judy, Colorado Health Initiative (Colorado)
Lisa Kaplan Howe, New Hampshire Voices for Health (New Hampshire)
Linda Katz, Economic Progress Institute (Rhode Island)
Trinka Kerr, Vermont Legal Aid (Vermont)
George Lyford, Colorado Center on Law and Policy (Colorado)
Sireesha Manne, New Mexico Center on Law and Poverty (New Mexico)
Claire McAndrew, Families USA (District of Columbia)
Teresa Mosqueda, Washington State Labor Council (Washington)
Jesse Ellis O'Brien, Oregon State Public Interest Research Group (Oregon)
Anna Odegaard, SEIU Healthcare Minnesota (Minnesota)
Jillian Phillips, Campaign for Better Healthcare (Illinois)
Leni Preston, Maryland Women’s Coalition for Health Care Reform (Maryland)
Elaine Saly, Families USA (District of Columbia)
Julie Silas, West Coast Office of Consumers Union (California)
Jason Stevenson, Utah Health Policy Project (Utah)
Cara Stewart, Kentucky Equal Justice Center (Kentucky)
Anna Strong, Arkansas Advocates for Children and Families (Arkansas)
Donna Sutton Fay, Vermont Campaign for Health care Security Education Fund (Vermont)
Anthony Wright, Health Access California (California)
Jill Zorn, Universal Health Care Foundation of Connecticut (Connecticut)

We would also like to appreciate the extensive data collection, analysis, and website development efforts of the following CBPP staff and interns:

Samuel Abbott
Kelsey Bogue
Valerie Caplan
Kyle Hayes
Nick Kasprak
Edward Bremner
Altelisha Taylor

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