Governance choices will shape Exchange operations, accountability, and the impact of the Exchange on health insurance markets. States will want to align governance decisions with their overall Exchange goals and priorities.

*Milestone details:

*Full name: Establish governance of the Exchange

*Relevance to the ACA:

The ACA requires that the Exchange be a nonprofit entity or governmental agency established by a state, but gives states great flexibility within these broad parameters. Sections relevant to Exchange governance include:

§1311 - Creates grants for states to plan and launch Exchanges. Requires Exchanges to be nonprofit entities or governmental agencies.

§1321 - Requires the Secretary to give guidance related to the creation of Exchanges. This section also gives the Secretary the power to establish and operate an Exchange in a state that defers or whose Exchange does not meet statutory requirements.