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You have requested an updated memorandum concerning the effect of section 1311(e)(1)(B) of the Patient Protection and Affordable Care Act (PPACA). Specifically, you have asked whether this section would allow a state, through its governor or other state official, to disallow private plans from participating in a state’s health benefit exchange, and whether this language could effectively be used to allow some type of state-sponsored health plan (i.e., a public health plan) to be the only insurance option offered. As discussed below, there is no specific language in PPACA that would prohibit an exchange from denying certification to every private plan that applies if the exchange were to determine that every plan is not in the “interest of plan participants.” However, it appears that the Secretary of Health and Human Services could use its authority to affect whether such a scenario would be permissible. Further, certain requirements of PPACA can prevent a state’s public health plan from being the only plan in a state’s exchange.