Maryland is an example of a state that has plowed forward to establish a health insurance exchange with a governing board put in place in June and preparations to hire organizations to examine operations models and other issues to recommend to lawmakers in December. Like other leading states, Maryland passed legislation this year for the authority to develop a health insurance exchange, said Josh Sharfstein, MD, Maryland Secretary of Health and Mental Hygiene. He is also a member of the Health IT Policy Committee, which advises the Office of the National Coordinator for Health IT. Maryland sees the exchange as one piece of the bigger healthcare puzzle, where cost is such an issue. There was broad consensus that Maryland should establish an exchange," he said at a July 27 conference sponsored by the Bipartisan Policy Center, the Kaiser Family Foundation, and the University of Virginia.