By Sarah Dash and Kevin Lucia

Only 16 states and the District of Columbia established state-based health insurance marketplaces in 2014, the first year of the Affordable Act Act’s major insurance expansions. These states cited numerous advantages, including greater autonomy over policy decisions and easier coordination with Medicaid. They used that flexibility to accomplish policy goals like improving consumer choice and health plan quality. However, the failure of information technology (IT) systems to reliably carry out basic marketplace functions upstaged more ambitious goals in many states.

As states plan for 2015, IT fixes have dominated operational decisions, and few states have moved to establish their own marketplaces or make bold policy changes. Arkansas remains the only state with a federally run marketplace to have enacted legislation granting it the necessary legal authority to establish a state-based marketplace. Only one state with a previously federally run marketplace—Mississippi—has opened its own small-business SHOP (Small Business Health Options Program) marketplace since last year.

In their latest blog post for the Commonwealth Fund, Sarah Dash and Kevin Lucia share findings on how IT issues and other factors are affecting state decisions to operate a state-based marketplace. Read more here.