This report analyzes how five characteristics of health insurance exchanges might address particular rural concerns.

Key Findings:

• Standards requiring that exchanges contract with Qualified Health Plans (QHPs) to provide an "optimal combination of choice, value, quality, and service" (see examples within California and Rhode Island statutes) could result in improved insurance markets in rural areas.
• Two states (Oregon and Hawaii) require geographic diversity among members of the exchange governing boards.
• Four states (Massachusetts, Oregon, Vermont, and Utah) require community-based activities to facilitate consumer enrollment into QHPs through the exchange; Massachusetts specifically requires outreach activities that target persons "who may require individualized support due to geography."
• All statutes and executive orders that we analyzed incorporate the network adequacy standards as stated in the ACA and subsequent regulations issued by CMS, which could require contracting with rural providers.