The Affordable Care Act includes a range of health insurance reforms that will lead to health care costs being shared more evenly between the healthy and the sick. Some experts have pointed to concerns that in the short term, there will be premium “rate shock” for some individuals, while in the long term, exchanges will be vulnerable to adverse selection if they attract a disproportionate number of older, sicker enrollees. Under the ACA, states have considerable flexibility to implement additional strategies to manage their markets and protect consumers. In collaboration with researchers at the Urban Institute, CHIR faculty members Sabrina Corlette and Sarah Dash examine states’ strategies to make premiums more affordable and protect the exchanges from potential adverse selection.