Health Insurance Exchanges in Health Care Reform: Legal and Policy Issues

The two health reform bills pending in Congress represent quite different understandings of what an exchange is, what it does, how it is organized, and how it functions. How those differences are resolved is likely to determine the extent to which the eventual exchanges accomplish their goals and whether they avoid the difficulties that have afflicted earlier attempts at creating and operating exchanges. This report describes design and function issues raised by exchanges, prior experience with exchanges, the provisions of the pending House and Senate bills that affect exchanges, and policy issues raised by the legislation.

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