New state insurance exchanges should follow the example of Massachusetts by simplifying choices among health plans.

Although the Affordable Care Act requires states to establish health insurance exchanges, states have considerable discretion in the exchanges' design and in the range of products offered. We argue for a more activist approach, based on the Massachusetts experience, which found that consumers want the exchange to act as a trusted adviser and to offer a reasonable set of choices, but not too many. These findings are reflected in the Medicare prescription drug, Advantage, and Medigap markets and in the Dutch and Swiss experiences, which validate the evolving approach of Massachusetts of limiting the number of options, standardizing products, and providing consumer supports.