In 2007, the state of Minnesota considered establishing a Health Insurance Exchange to serve small groups and individuals, facilitating access to coverage, choice among insurance products, portability of coverage, and affordability. Mathematica studied the coverage, cost, and fiscal impacts of a series of health reforms that might occur coincident with the implementation of the exchange—guaranteed issue and community rating of both small group and individual products, a mandate requiring all residents to obtain coverage, and a requirement that all employers with 11 or more employees offer a Section 125 or “cafeteria” plan. This report estimates the impacts of the reforms alone and in combination. In addition, it explores the range of implementation and legal issues that policymakers in Minnesota would need to address in order to develop an exchange.