Summary: What is a healthcare exchange? When do they become effective? When do states need to decide whether or not to participate?
An exchange is an online marketplace created at the state level for consumers to be able to shop for insurance. The exchanges are a part of the Affordable Care Act which was enacted in 2010 with individual effective dates spanning from 2010-2015. Specifically, the healthcare exchanges become effective and must be in place in 2014. The ACA gives states the option whether or not to create a state exchange. Any state electing not to create an exchange will have one created for them by the federal government.
The deadline for states to decide whether or not to create a state health insurance exchange, which was originally set for November 16, is extended until December 14, 2012. The extension was spurred by the Republican Government Association who were hoping Mitt Romney would be elected and the Affordable Care Act would be repealed.