The Commonwealth Fund  |  July 11, 2013

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The Affordable Care Act requires the establishment of new health insurance marketplaces—known as individual exchanges and Small Business Health Options (SHOP) exchanges—in each state. States must make complex decisions about how to design their exchanges in ways that reflect the unique needs of their consumers and insurance market. This report examines key structural, operational, and policy decisions made by 17 states and the District of Columbia that chose to establish a state-based exchange for 2014.

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