From the Summary: "Pursuant to the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), a health insurance exchange has been established in each state and the District of Columbia (DC). Exchanges are marketplaces where individuals and small businesses can 'shop' for health insurance coverage. The ACA provides that states may establish their own state-based exchanges (SBE), and as of January 2014, 14 states and DC have done so. It also directs the Department of Health and Human Services (HHS) to establish exchanges in states that do not establish SBEs, and 36 states have federally-facilitated exchanges (FFE) in 2014. In some states that have FFEs, the states carry out certain functions of the exchange; in other states, the exchange is wholly operated and administered by HHS. The ACA provided an indefinite appropriation for HHS grants to states to support the planning and establishment of exchanges. For each fiscal year, the HHS Secretary is to determine the total amount that will be made available to each state for exchange grants. No grant may be awarded after January 1, 2015."
CRS Report for Congress, R43066