Texas has not established its own health benefit exchange. Under the Affordable Care Act, who is responsible for operating a Marketplace in a state that does not establish its own exchange?

Why B is correct

Under ACA Section 1321, a state may elect to establish and operate its own American Health Benefit Exchange, but if a state does not do so, or is not approved to operate one, the Secretary of Health and Human Services must establish and operate such exchange within that state. The practical consequence for Texas is that individuals and small employers enroll through the federally facilitated Marketplace operated by HHS, while the Texas Department of Insurance continues to regulate the issuers whose plans are sold there.

Why the other options are wrong

• A) The department of insurance regulates insurers; it does not step in to operate an exchange that the state has chosen not to establish.
• C) The NAIC develops model laws and standards, but it has no statutory role in operating an exchange under ACA Section 1321.
• D) Counties have no exchange operating role under the statute. The fallback operator named by the ACA is the Secretary of HHS.

Memory hook

No state exchange means HHS runs the Marketplace.