State Perspectives on Insurance Exchanges: Implementing Health Reform in an Uncertain Environment

The three major components of the Patient Protection and Affordable Care Act of 2010 (ACA) — insurance reform, Medicaid expansions, and the establishment of health insurance exchanges — are primarily the states’ responsibilities to implement; together they impose a daunting workload. Because insurance exchanges must be wholly created in a very short time period, their implementation presents unique challenges.

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