Connolly and Keckley say there is no way of knowing what these exchanges will look like or how much they will vary from state to state.
"You've got 30 Republican governors now and most of the Red persuasion will move towards that active shopper model," Keckley says. "It's all over the place on the other states, but the tendency in most states is to allow multiple plans to participate if they hit the metrics on essential health benefits and they can comply with enrollment and eligibility standards."
"I think the feds will relax some of those requirements so it is easier for states to see that plans are stepping up and putting products on the exchange. The worst outcome is if this effort is made but the commercial plans say ‘I'll pass.'"
Connolly predicts that some of the biggest state-to-state variances will center on what benefits are offered based on cultural and regional population health issues.
"There are different demographics in different states," she says. "I could see in Arizona or Florida you may want products geared toward the pre-retiree age group. If you are in Texas or California you might want to think more about an immigrant population."