State Insurance Exchanges

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An important aspect of the Affordable Care Act is the development of State Health Insurance Exchanges, or marketplaces, that will help consumers and small businesses shop for quality, affordable healthcare coverage. The ANA has closely monitored the federal guidance on exchanges, and many state nursing associations have been actively involved in developments at the state level.  We urge nurses to learn about developments in your state, and to be actively involved in shaping this feature of healthcare reform.

The existing insurance marketplace creates a significant barrier to advanced practice registered nurses (APRNs), since only about half of all private insurers currently credential and directly reimburse APRNs.  The development of state health insurance exchanges provides an opportunity to educate policymakers about the importance of providing consumers access to APRN care through the expanding private market.

This ANA Issue Brief, State Health Insurance Exchanges: The Critical Role of Nurses and Nursing, provides the basic information about exchanges and an overview of ANA’s advocacy. 

ANA responded to the proposed regulations on the development of state exchanges.  They can be found on ANA's regulatory comments page.

The creation of State Insurance Exchanges – an online marketplace where individuals can purchase health plans – provides an opportunity for the federal government to simplify and standardize state regulations and insurance industry policies that have been barriers to APRN practice. ANA urged that “network adequacy standards” must include the requirement that APRNs are providers, and that the list of “essential community providers” must include nurse-managed health centers, school-based health centers, and birth centers.

ANA responded to request for input on the Essential Health Benefits package. ANA analyzed the interim final rule to compare the recommendations from our comments with the actual rule.


  • is a consumer advocacy organization that presents and interactive tool with updated status of State Health Exchanges in each State in simple terms, directed at consumers.
  • Kaiser Family Foundation is an independent, private, non-profit foundation that conducts research and policy analysis on major health issues in the United States. Their website offers and interactive tool to monitor status of Health Exchanges in all States
  • The National Conference of State Legislatures (NCSL) is a bipartisan organization that serves the legislators and staffs of the nation's 50 States, its commonwealths and territories. Their interactive tool provides the level of detail that State legislators and policy-makers need to keep abreast of the status of Health Exchanges in all States.
  • The National Association of Insurance Commissioners offers in-depth information about calculating the Medical Loss Ratio.
  • Center for Consumer Information and Insurance Oversight (CCIIO) is the division of CMS that proposes and implements rules and guidance for the State Health Insurance Exchanges.