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This issue brief from Academy Health, funded by the Robert Wood Johnson Foundation, describes some of the key implementation issues that states should consider in establishing state health insurance exchanges as part of the implementation of national health care reform.  Among the key issues to be considered:

* governance structure and administration

* key functions and responsibilities

* operation of the exchange alongside the state’s commercial health insurance markets

* rules governing insurance carrier participation in the exchange

* risk selection, inside and outside the exchange

* the interaction between the exchange and the state’s Medicaid program and Children’s Health Insurance Program

* the type and level of customer service that the exchange will need to provide

* whether states should establish their own exchange or defer that responsibility to the federal government.  

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