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State politics and the creation of health insurance exchanges
1Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA. davidkj@umich.edu
Abstract:
Health insurance exchanges are a key component of the Affordable Care Act. Each exchange faces the challenge of minimizing friction with existing policies, coordinating churn between programs, and maximizing take-up. State-run exchanges would likely be better positioned to address these issues than a federally run exchange, yet only one third of states chose this path. Policymakers must ensure that their exchange-whether state or federally run-succeeds. Whether this happens will greatly depend on the political dynamics in each state.
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