Texas has not elected to establish a state-based health insurance exchange. What is the consequence for Texas residents and for the agents who assist them?

Why D is correct

Under ACA Section 1321, a state may elect to establish a state-based exchange; if it does not, the federal government must establish and operate a federally facilitated exchange in that state. Texas did not establish a state exchange, so consumers and their agents use the federally facilitated Marketplace, where premium tax credits and cost-sharing reductions remain available; the agent still must hold a Texas license and appointment to solicit and enroll, because federal operation of the exchange does not displace Texas licensing law.

Why the other options are wrong

• A) Exchanges are established at the state level or by the federal government, never county by county.
• B) Marketplace coverage is available in Texas; ACA Section 1321 requires the federal government to operate an exchange where the state has not created one.
• C) The department regulates insurers and agents in Texas; it does not operate the Marketplace, which is a federal function under ACA Section 1321 in a state like Texas.

Memory hook

No state exchange means federal Marketplace, Texas license still required.