Building the Infrastructure for a New York Health Benefit Exchange: Key Decisions for State Policymakers

American Health Benefit Exchanges are the centerpiece of health insurance reforms in the Affordable Care Act (ACA). Under tight timeframes, all states are required to establish these entities, or cede that authority to the federal Department of Health and Human Services (HHS). Modeled on Massachusetts’s Connector, the Exchange will straddle public and private health insurance markets, and is charged with a broad range of duties. Some obligations — determining eligibility for tax subsidies to make coverage more affordable, facilitating enrollment in public coverage, and overseeing compliance with individual respon- sibility provisions — resemble traditional governmental activities. Others — creating an electronic marketplace for insurance shopping — have a more commercial flavor.