For some of the states that managed to pass exchange bills this year, the fight over implementing health reform is far from over. Showing that no battle is too small when it comes to health care reform, patient advocates are worried about the insurance industry influencing governance boards overseeing the health exchanges. That's because the governance boards could be tapped to handle a lot of the heavy lifting on key policy questions, such as which health plans can sell on the exchanges and how to finance the online insurance marketplace and prevent conflicts of interest. Exchange governance boards will be busy between now and January 2013, when Health and Human Services must determine whether a state's exchange passes muster. Building an exchange -- an online marketplace where consumers can shop and compare health plans -- will require information technology expertise, as well as an intimate understanding of how insurance markets operate. Ultimately, the boards will be responsible for striking the right balance between meeting consumer needs and supporting viable insurance marketplaces for the 24 million projected to enroll in exchanges by the end of the decade.