This brief addresses some of the issues that states will need to consider in making decisions about the health insurance exchanges that are a central part of the health insurance coverage strategy in the Patient Protection and Affordable Care Act (ACA) enacted in March of 2010. Specifically, it discusses the issues that states will face in making decisions about how to structure health insurance exchanges and health insurance markets.  The brief is a collaboration between SHADAC and State Coverage Initiatives.  November 2010.