Health Insurance Exchanges in Health Care Reform Legal and Policy Issues

Health insurance exchanges play an important role in pending health care reform legislation. This paper first examines the different ways in which exchanges could be designed in a reformed health care system and the different roles that they could play. The paper next briefly explores experience with exchanges and what we can learn from it. It then describes the different approaches taken by the three bills pending in Congress to exchange design and function. The following section examines the legal issues raised by exchanges as they are defined in the pending legislation. Finally, the paper concludes with policy recommendations as to how exchanges should be designed and function to play an effective role in a reformed health care system, noting in particular the strengths and weaknesses of the pending legislation.