PPACA required by 1 January 2014, the establishment in each state of health insurance exchanges -- marketplaces where eligible individuals and small businesses can compare and select among insurance plans. Issuer participation, including the number of plans these issuers offer, is a key factor in the extent of consumer choice offered by the exchanges. The United States Government Accountability Office (GAO) was asked to examine the number and types of issuers participating in both the individual and small-business exchanges beginning in 2014, as well as how this compared with issuer participation in the individual and small-group markets prior to the exchanges. In this book, GAO describes the extent to which issuers that previously offered health plans in the individual and small-group markets participated in the exchanges in 2014; and the issuers that participated in 2014 exchanges and the health plans they offered. This book also describes Small Business Health Options Programs (SHOPs) functionality, enrollment, plan availability, and premiums; and stakeholders' views on key factors that have affected current SHOP enrollment or may affect future enrollment growth.