"There are significant costs to throwing out a ...

...  [state insurance exchange] system that you've spent tens of millions — and in some cases hundreds of millions of dollars — developing. There are a lot of costs related to unwinding and dealing with health plans that are dependent on that old system. There is also a huge political risk. There could be egg on the face of people who propose throwing a $100 million IT system out the window for something better. You want to be able to prove the case that this will be less expensive in the long run. This strategy might be more appealing to a partnership or [federally facilitated exchange] state that is looking to build its own exchange from scratch. They wouldn't face the politics of switching IT systems."

— Jon Kingsdale, Ph.D., the founding executive director in 2006 of the Massachusetts Commonwealth Insurance Connector and now a director at Wakely Consulting in Boston, told AIS's Inside Health Insurance Exchanges.