Saturday the Yale Health Law & Policy Society held a fascinating conferenceon health insurance exchanges – early challenges and opportunities. Speakers included academics, advocates, state officials and private consultants. Focusing across the US, speakers highlighted the differences between states, and between the federal exchange, state-run exchanges, and the models between those two. Speakers addressed concerns about the ages of early enrollees (whether too many older, presumably more expensive members, could create a death spiral), disappointing enrollment numbers (and lowering expectations), market influences – inside and outside exchanges, the politics of exchanges, legal challenges (this was really entertaining – legislators can be very creative in undermining a federal law they don’t like), churn how it affects insurer incentives, the power of choice architecture, how exchanges fit into the bumpy landscape of ongoing delivery and payment reforms, affordability (or the lack of it), the expanding list of states expanding Medicaid through exchanges and premium assistance, states blocking navigators and consumer assistance, best practices in outreach, and a lot more. Smart speakers and great student questions — I learned a lot.