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Health insurance exchange decisions by state

Learn how each state approaches health insurance exchanges under the Affordable Care Act and what it means for employers.

by the Brightmine Editorial Team

Through the creation of state-based health insurance exchanges, the Affordable Care Act (ACA) creates a competitive marketplace from which individuals and small businesses may purchase affordable health insurance.

Every state and the District of Columbia is required to have an exchange that is either:

  • Federally facilitated (operated by the US Department of Health and Human Services);
  • State-based;
  • State-based operated on the federal platform; or
  • A planned partnership with the federal government.

The following chart identifies state decisions for creating health care exchanges.

Screenshot of the Brightmine Fifty State Chart on eeo protected classes

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Latest updates

Updated to reflect Illinois shift to state-based health exchange beginning January 1, 2026.

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The Brightmine Editorial Team

Our in-house team of HR experts carefully monitors and updates the Brightmine HR & Compliance Center, the most comprehensive library of employment law and HR resources. This team has an unrivaled wealth of subject matter expertise, with an average of 15 years’ experience. They also bring invaluable, diverse career experiences to the table—the team includes seasoned employment law attorneys, former in-house counsel, SHRM certified professionals and career employment law editors.

In addition to managing the HR & Compliance Center, the Editorial Team supports the content across the Brightmine product portfolio. The Team also supports Marketing Resource Center with breaking HR news, Commentary and Insights, and expert review of key compliance resources, such as our free charts.

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