Abstract

Health insurance exchanges can organize the market for health insurance by connecting small businesses and individuals into larger insurance pools. HIEs have been proposed as a possible means of making insurance more accessible, increasing competition among health plans, and promoting choice of insurer. President Obama's campaign proposal and various congressional leaders have proposed establishing insurance exchanges through federal legislation. However, whether the federal or state government, or even a private entity, can organize an insurance exchange to connect health insurance sellers and buyers under the law is the question explored in this paper. Specifically, the paper addresses legal restraints or limitations to such an exchange at the federal, state or private entity level, and offers solutions. Although exchanges implicate many design and policy issues regardless of whether they are implemented at a federal, state, or private entity level, the paper concludes that are no absolute legal bars to the establishment of health insurance exchanges