Under the Affordable Care Act (ACA), New York must create an insurance Exchange—a statewide marketplace for health insurance. New York can also benefit from Federal funding available to States that take action immediately to establish their Exchanges. New York has long been a leader in providing quality affordable coverage to residents. The Exchange offers many opportunities to build on our achievements, but there are many complicated questions to answer in designing a strong, consumer-friendly Exchange. State officials must begin working with consumers to address these questions immediately.