Considering a Health Insurance Exchange Lessons from the Rhode Island Experience

A health insurance exchange transforms the way health insurance is packaged, subsidized (for low-income individuals and families), and purchased. This brief describes the process followed in Rhode Island to explore establishing a health insurance exchange-like organization, HealthHub RI, based on the Massachusetts model. The RI experience demonstrated the importance of clearly defining the goals of an exchange, as well as understanding that exchanges may do little to constrain the growth of health care costs. States considering an exchange might want to consider an affordability-based mandate, requiring all state residents to have health insurance coverage that meets an exchange-specified standard, as long as it is deemed affordable.