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Policy Innovations in the Affordable Care Act Marketplaces

Photo, woman standing outside of bookshop with arms crossed

Jill Swenson stands outside a bookshop in Appleton, Wis., on Nov. 27, 2021. The Affordable Care Act made coverage accessible to Swenson, but paying for it was still a stretch; premium subsidies have helped. ACA marketplaces have adopted policies that connect consumers to coverage by reducing administrative burdens, helping them navigate their plan options, and taking steps to reduce health and coverage disparities. Photo: Sara Stathas/New York Times via Redux.

Jill Swenson stands outside a bookshop in Appleton, Wis., on Nov. 27, 2021. The Affordable Care Act made coverage accessible to Swenson, but paying for it was still a stretch; premium subsidies have helped. ACA marketplaces have adopted policies that connect consumers to coverage by reducing administrative burdens, helping them navigate their plan options, and taking steps to reduce health and coverage disparities. Photo: Sara Stathas/New York Times via Redux.

Toplines
  • With enrollment in the ACA marketplaces at a record high and expected to grow further, many states are experimenting with ways to make shopping for the right health care coverage easier and more efficient for consumers

  • State insurance marketplaces have pursued innovations that help consumers navigate their plan options, reduce administrative burdens, require or incentivize insurer participation, and address disparities in coverage and care

Toplines
  • With enrollment in the ACA marketplaces at a record high and expected to grow further, many states are experimenting with ways to make shopping for the right health care coverage easier and more efficient for consumers

  • State insurance marketplaces have pursued innovations that help consumers navigate their plan options, reduce administrative burdens, require or incentivize insurer participation, and address disparities in coverage and care

Abstract

  • Issue: Enrollment in the Affordable Care Act (ACA) marketplaces is at an all-time high, and sign-ups are expected to increase as Medicaid redeterminations resume. These gains, alongside a more stable legal and political environment relative to the ACA’s early years, may provide opportunities for marketplaces to pursue innovative and consumer-friendly policies that bolster this crucial source of affordable, comprehensive health insurance.
  • Goal: Identify key policy decisions across the ACA marketplaces aimed at improving consumers’ access to and experience shopping for coverage that meets their health and financial needs.
  • Methods: We reviewed policy decisions made by the 21 state-run marketplaces and the federally facilitated marketplace for 2023, including efforts to reduce enrollment barriers, simplify plan choice, promote market competition, and increase health equity.
  • Key Findings: Marketplaces have adopted policies designed to connect consumers to coverage by reducing administrative burdens, helping consumers navigate their plan options, requiring or incentivizing insurer participation, and taking steps to reduce health and coverage disparities.
  • Conclusion: Marketplace policy innovations have helped strengthen a crucial part of the safety net. However, some policies that hold promise for improving coverage access have yet to be adopted broadly, and wide variation across states suggests a need for nationwide implementation of some of the policies identified.

Introduction

More people than ever rely on the Affordable Care Act (ACA) marketplaces for health insurance.1 Millions more will become eligible for marketplace coverage after losing Medicaid as the pandemic-related pause on redeterminations comes to an end.2 Amidst this flurry of enrollment activity, policymakers running the ACA marketplaces shoulder the great responsibility of connecting consumers to affordable coverage that meets their health and financial needs. After years of attempts to overturn the ACA in Congress and at the Supreme Court, the marketplaces, now in a relatively stable political and legal environment, may have an increased opportunity to pursue innovative and consumer-friendly policies.

How the ACA Marketplaces Transformed Individual Insurance

While most Americans are insured through their employers or public programs, such as Medicare or Medicaid, more than 18 million people depend on the private individual health insurance market for coverage.3

The ACA transformed this insurance market. Before the ACA, people purchasing insurance on the individual market faced significant barriers to comprehensive and affordable coverage. Insurers competed through discriminatory policies, benefit designs, and pricing schemes, frequently denying insurance applications, creating products designed to cherry-pick healthy individuals, or offering only paltry or unaffordable coverage to people with preexisting conditions.4 Consumers lacked a neutral, centralized source of information about insurance products, making it difficult to compare plans.5

The ACA outlawed these discriminatory practices in the individual market and created “marketplaces,” a one-stop shopping experience on a trusted government website to enroll in federally subsidized health insurance plans that meet a common set of coverage standards. Marketplaces were meant to foster competition on price and value, facilitate meaningful plan comparison, and allow consumers to enroll in affordable, comprehensive private coverage.6

Marketplaces were originally envisioned as a state-operated mechanism. However, in part because of opposition to the ACA, most states initially ceded responsibility for running their marketplace — and with it, the opportunity to use these platforms to drive state innovation — to the federal government.7 In 2023, 20 states and the District of Columbia (D.C.) operate a state-based marketplace using a state-run eligibility and enrollment website (SBM) or a state-based marketplace using the federal eligibility and enrollment website, HealthCare.gov (SBM-FP). The remaining 30 states rely on the federally facilitated marketplace (FFM) (Exhibits 1 and 2).

When the marketplaces launched in 2013, website failures and political opposition to the ACA hindered enrollment efforts.8 After some progress in the first couple of years, enrollment dipped again between 2017 and 2020 amidst federal policies that undermined the marketplaces, lackluster insurer participation, and significant premium increases.9 But following congressional action to expand federal premium subsidies, and under the stewardship of a more supportive administration, marketplace enrollment rebounded, with a record 16.4 million people selecting a marketplace plan in 2023 — more than double the enrollment seen in the inaugural sign-up period.10

Schwab_policy_innovations_ACA_marketplaces_Exhibit_01
Schwab_policy_innovations_ACA_marketplaces_Exhibit_02

The large number of people relying on the marketplaces for health insurance underscores the importance of crafting policies that promote quality and affordable plan options as well as procedures that make it easy to shop for, enroll in, and maintain coverage. This brief identifies key policies adopted by the ACA marketplaces designed to remove known obstacles to accessing the comprehensive, affordable coverage available through the marketplaces and support health and financial well-being, including marketplace efforts to reduce enrollment barriers, simplify plan choice, promote market competition, and increase health equity. We reviewed these policies across the 18 SBMs, the three SBM-FPs, and the FFM for 2023.

Key Findings

Reducing Enrollment Barriers

The ACA reduced the uninsured rate to an historic low, but around 8 percent of people still lack coverage, including people who are eligible for subsidized marketplace plans.11 Some of the eligible but uninsured are deterred by the administrative burden of enrolling in coverage, reducing sign-ups and take-up of available financial assistance.12 Marketplaces have adopted policies to help alleviate this burden and make it easier to enroll in subsidized health plans (Exhibit 3).

Many marketplaces have implemented policies that aim to remove enrollment obstacles by streamlining and even automating the sign-up process. Five SBMs have used the flexibility afforded by a state-run eligibility and enrollment website to establish “Easy Enrollment” programs that allow residents to indicate on their tax forms if they are uninsured and interested in coverage.13 The state then uses income information from the return to provide an eligibility determination and direct the consumer to Medicaid or a midyear enrollment window for subsidized marketplace plans.14 Beyond tax filing Easy Enrollment programs, this simplified sign-up process can also operate through other contact points between states and consumers. Maryland, for example, allows people filing unemployment insurance claims to check a box to receive information about affordable health insurance options, and the marketplace offers an enrollment opportunity if they are eligible for marketplace coverage.15 Four SBMs have set up auto-enrollment programs, eliminating the need for consumers to actively select a plan and preventing coverage gaps when consumers transition between Medicaid and the marketplace.16 Some states operating SBMs have subsidized premiums for auto-enrolled individuals, reducing or in some cases removing the burden of paying premiums to effectuate enrollment.17

The FFM has also adopted policies intended to make enrollment easier. In addition to extending the open enrollment period into January in all 33 states that use HealthCare.gov, federal regulators established a new special enrollment period that allows individuals and families with lower incomes — who disproportionately lack health insurance — to enroll in marketplace plans throughout the year.18 Sixteen SBMs offer some version of a low-income special enrollment period, including several SBMs that expanded the policy’s reach by setting income eligibility thresholds higher than the federal cutoff of 150 percent of the federal poverty level.19 Meanwhile, to ease transitions to the marketplace for the millions of individuals being disenrolled from Medicaid during the resumption of eligibility redeterminations, the FFM opened an extended and more flexible special enrollment period until July 2024.20 All but two SBMs have adopted a new, extended special enrollment period for this population.21

Schwab_policy_innovations_ACA_marketplaces_Exhibit_03

Simplifying Plan Choice

Although the ACA marketplaces made it easier for consumers to compare options across insurance companies, selecting the right plan remains a challenge.22 The complexity of comparing premiums, cost-sharing structures, benefit designs, provider networks, and formularies is exacerbated by the dramatic increase in plan options on the marketplaces — the average number of qualified health plans available to consumers shopping on HealthCare.gov more than quadrupled between 2019 and 2023.23 “Choice overload” and the challenges of comparing complex insurance products can lead consumers to make suboptimal plan selections or even abandon the enrollment process altogether.24

Marketplaces have taken a variety of approaches to simplifying plan choice (Exhibit 4). In plan year 2023, all marketplaces that use HealthCare.gov and nine SBMs required plan standardization, mandating that insurers offer at least some marketplace-designed plans with identical cost-sharing structures (deductibles, copayments, and coinsurance) within a given metal tier. This standardization allows consumers to more easily compare qualified health plans based on characteristics like premiums and provider networks.25 Standard plans are also a vehicle for marketplaces to reduce or eliminate cost sharing for certain health services, which can improve the value of qualified health plans and lessen health disparities.26 Seven SBMs also tackled choice overload this year by limiting the number of nonstandard plans or otherwise capping the number of qualified health plans an insurer can propose or offer. Next year, the FFM will limit the number of nonstandard plans insurers can offer on HealthCare.gov.27 And in 2023, nine SBMs required that an insurer offer additional plans only if they are “meaningfully different” from the insurer’s other products, putting downward pressure on the number of plan options consumers have to compare.

Schwab_policy_innovations_ACA_marketplaces_Exhibit_04

Promoting Market Competition

Competition between insurers drives the availability and affordability of plans for consumers who depend on the marketplace for coverage. Greater insurer participation is associated with lower premiums.28 Participation has fluctuated over the marketplaces’ 10-year lifespan, and insurer exits led to a serious threat of counties with no available marketplace plans in 2018.29 Six SBMs have implemented policies that require or incentivize insurer participation (Exhibit 5). For example, Massachusetts requires that insurers with more than 5,000 enrollees in the combined individual and small-group market file a response to the plan certification solicitation issued by the marketplace.30

Some SBMs condition insurers’ eligibility to contract with the state for other lines of business — such as the Basic Health Program (New York) or certain public employee health benefit plans (Washington) — on marketplace participation.31

Schwab_policy_innovations_ACA_marketplaces_Exhibit_05

Advancing Health Equity

Although the ACA helped reduce racial and ethnic disparities in health coverage and care access, health inequities persist, even among the insured.32 Marketplaces have adopted policies aimed at improving health equity among enrollees, including through the rules and standards for participating insurers (Exhibit 6). Equity-based insurance design requirements, implemented by five SBMs as of 2023, are intended to increase access to care that prevents and treats conditions with known racial and ethnic disparities, including diabetes, maternal health, asthma, and hypertension.33 For instance, the D.C. marketplace requires standard plans to include $0 cost sharing for specified medical devices, medications, and health services for patients with diabetes.34

A small but growing number of SBMs require insurers to obtain health equity–related accreditation from the National Committee for Quality Assurance, which assesses how effectively health insurers advance health equity across several dimensions, including demographic data collection and reporting practices, the provision of culturally and linguistically appropriate services, and affirmative steps to reduce health inequities and improve care quality.35

Finally, four SBMs require insurers to collect and report race and ethnicity data to help quantify and reduce disparities and inequities in insurance coverage, health care access, and health outcomes.36 In a similar vein, federal regulators will soon require all insurers that participate in the marketplace risk adjustment program to “make a good faith effort” to collect and submit enrollees’ race and ethnicity data.37

Schwab_policy_innovations_ACA_marketplaces_Exhibit_06

Discussion

The Affordable Care Act marketplaces are now a fixture in the health insurance landscape. Though enrollment is modest compared to other sources of coverage, marketplaces provide health insurance to some of the most under-resourced communities, including workers without employer coverage, families just over the income cutoff for Medicaid, and people who lose their health plan. Marketplaces also allow people to change jobs, start their own business, or retire by serving as a reliable source of affordable, quality coverage for people without access to job-based insurance. The role of the marketplaces takes on additional importance when access to other sources of coverage is disrupted, such as during the COVID-19 pandemic or the current “unwinding” of continuous Medicaid coverage, when 15.5 million people are expected to lose Medicaid.38

Today, a record number of people rely on the marketplaces for coverage, and millions of uninsured individuals are eligible for subsidized marketplace plans.39 Many marketplaces have risen to the occasion, adopting policies that seek to encourage enrollment, help consumers identify the best plan for their health and financial needs, promote insurer participation, and advance health equity. These range from innovative policies, such as Easy Enrollment and auto-enrollment programs; tried and true tools, including plan standardization; and policies that lay the groundwork for future action, like data collection requirements to better understand health and coverage disparities.

Wide variation in marketplace policies across states, however, has created a patchwork of marketplace enrollment procedures and plan standards, likely leading to different enrollment experiences and outcomes for consumers. Both the FFM and SBMs have established innovative policies later adopted by some, but not all marketplaces, including the federal low-income special enrollment period and standard plan requirements. Nationwide adoption of these policies, as well as other proactive efforts to bolster and expand access to this crucial source of coverage, could lead to more consistently consumer-friendly marketplaces in every state.

NOTES
  1. Centers for Medicare and Medicaid Services, “Biden–Harris Administration Celebrates the Affordable Care Act’s 13th Anniversary and Highlights Record-Breaking Coverage,” press release, Mar. 23, 2023.
  2. Matthew Buettgens and Andrew Green, The Impact of the COVID-19 Public Health Emergency Expiration on All Types of Health Coverage (Urban Institute, Dec. 2022).
  3. KFF, “Health Insurance Coverage of the Total Population,” Timeframe: 2022, n.d. The total individual-market enrollment referred to accounts for enrollment in non-ACA-compliant plans, including grandfathered plans and short-term, limited duration insurance. Enrollment in the ACA-compliant individual market has been estimated to be approximately 15.5 million people, as of mid-2022. See Jared Ortaliza, Krutika Amin, and Cynthia Cox, As ACA Marketplace Enrollment Reaches Record High, Fewer Are Buying Individual Market Coverage Elsewhere (KFF, Sept. 2023).
  4. Sabrina Corlette, Linda J. Blumberg, and Kevin Lucia, “The ACA’s Effect on the Individual Insurance Market,” Health Affairs 39, no. 3 (Mar. 2020): 436–44.
  5. Justin Giovannelli, Emily Curran, and Kevin Lucia, “As Health Plans Become Less Standardized, Consumer Decision-Support Tools Will Be Critical,” To the Point (blog), Commonwealth Fund, Aug. 30, 2017.
  6. Patient Protection and Affordable Care Act, Pub. L. 111-148, § 1311, 124 Stat. 119, 173–81 (2010).
  7. 42 U.S.C. §§ 18031, 18041(c); and Christine Vestal, “Utah’s Health Insurance Exchange in Limbo,” Stateline, Jan. 11, 2013.
  8. Elise Hu, “Tech Problems Plague First Day of Health Exchange Rollout,” NPR, Oct. 2, 2013; and Michael Tesler, “More Democrats Are Getting Health Insurance, Thanks to Obamacare. Why Are Republicans Staying Away?,” Washington Post, July 16, 2015.
  9. KFF, “Marketplace Enrollment, 2014–2023,” n.d.; Sabrina Corlette and Rachel Schwab, “States Lean in as the Federal Government Cuts Back on Navigator and Advertising Funding for the ACA’s Sixth Open Enrollment,” To the Point (blog), Commonwealth Fund, Oct. 26, 2018; Sabrina Corlette et al., Stepping into the Breach: State Options to Protect Consumers and Stabilize Markets in the Wake of Federal Changes to the Affordable Care Act (Georgetown University Center on Health Insurance Reforms, Aug. 2017); Daniel McDermott and Cynthia Cox, Insurer Participation on the ACA Marketplaces, 2014–2021 (KFF, Nov. 2020); and John Holahan, Erik Wengle, and Caroline Elmendorf, Marketplace Premiums and Insurer Participation: 2017–2020 (Urban Institute, Jan. 2020).
  10. American Rescue Plan Act of 2021, Pub. L. 117-2, § 2801, 135 Stat. 4, 49 (2021); Inflation Reduction Act of 2022, Pub. L. No. 117-169, § 12001, 136 Stat. 1818, 1905–06 (2022) (extending the American Rescue Plan Act’s enhanced premium subsidies through 2025); Centers for Medicare and Medicaid Services, “The Inflation Reduction Act Lowers Health Care Costs for Millions of Americans,” press release, Oct. 5, 2022; KFF, “Marketplace Enrollment, 2014–2023,” n.d.; and Sabrina Corlette and Joan Alker, “A Midterm Assessment of President Biden’s Promise to Build on the ACA,” Health Affairs Forefront (blog), Feb. 3, 2023.
  11. Aiden Lee et al., National Uninsured Rate Reaches All-Time Low in Early 2022 (Office of the Assistant Secretary for Planning and Evaluation, Aug. 2022); and Jennifer Tolbert, Patrick Drake, and Anthony Damico, Key Facts About the Uninsured Population (KFF, Dec. 2022).
  12. Tolbert, Drake, and Damico, Key Facts, 2022 (describing how almost 20 percent of uninsured nonelderly adults cite the difficulty or complexity of signing up as a reason for their lack of health insurance coverage); Keith Marzilli Ericson et al., Reducing Administrative Barriers Increases Take-Up of Subsidized Health Insurance Coverage: Evidence from a Field Experiment (National Bureau of Economic Research, Jan. 2023); and Stan Dorn, Helping Special Enrollment Periods Work Under the Affordable Care Act (Urban Institute, June 2016) (finding onerous verification requirements for special enrollment periods (SEP) deters take-up among people eligible for a SEP).
  13. Rachel Schwab et al., “State Easy Enrollment Programs Gain Momentum, Lay Groundwork for Additional Efforts to Expand Coverage,” To the Point (blog), Commonwealth Fund, Aug. 3, 2021.
  14. Schwab et al., “State Easy Enrollment,” 2021.
  15. See Md. Code Ann. Lab. & Empl. § 8-109(b) (2023); and Md. Code Ann. Ins. § 31-108(h) (2023).
  16. See, for example, Rachel Schwab, Justin Giovannelli, and Kevin Lucia, “California’s Marketplace Tries New Tactics to Reduce the Number of Uninsured and Underinsured,” To the Point (blog), Commonwealth Fund, Mar. 31, 2022.
  17. Rhode Island’s marketplace will pay the first two months of premiums for residents with household incomes below 250 percent of the federal poverty level who are transitioning off of Medicaid, and the marketplace will automatically enroll those below 200 percent of poverty. HealthSource RI Advisory Board, “Draft Meeting Minutes,” Jan. 26, 2023. California, which has an auto-enrollment program for residents who lose Medicaid and are eligible for subsidized marketplace plans, has also funded a $1 subsidy to cover the portion of premiums attributable to non-Hyde abortion services, which federal premium subsidies do not cover. Schwab et al., “California’s Marketplace Tries,” 2022. Maryland, which also has an auto-enrollment program, recently passed legislation to create a premium subsidy similar to California’s $1 premium subsidy. Md. Code Ann. Ins. § 31-122(g). For additional information about premium burdens and enrollment outcomes, see Adrianna L. McIntyre, Mark Shepard, and Myles Wagner, Can Automatic Retention Improve Health Insurance Market Outcomes? (National Bureau of Economic Research, Apr. 2021) (“[E]ven nominal premiums can deter enrollment in low-income groups.”).
  18. 45 C.F.R. 155.420(d)(16) (2023); and Tolbert, Drake, and Damico, Key Facts, 2022.
  19. This total includes SBMs where expanded Medicaid or a Basic Health Program (BHP) covers individuals who would otherwise be eligible for a low-income SEP but who can already enroll in affordable coverage throughout the year.
  20. Centers for Medicare and Medicaid Services, “Temporary Special Enrollment Period (SEP) for Consumers Losing Medicaid or the Children’s Health Insurance Program (CHIP) Coverage Due to Unwinding of the Medicaid Continuous Enrollment Condition — Frequently Asked Questions (FAQ),” Jan. 27, 2023.
  21. Some SBMs have established an SEP modeled after the FFM’s “unwinding” SEP, while other SBMs have adopted new SEPs with slightly different parameters for consumers losing Medicaid during the unwinding of the continuous coverage policy. A preexisting SEP, such as the 60-day loss of minimum essential coverage SEP, does not constitute an unwinding SEP. While Covered California does not offer an unwinding SEP for plan year 2023, they have partially automated enrollment for consumers who lose Medicaid and are eligible for subsidized marketplace coverage. Schwab et al., “California’s Marketplace Tries,” 2022.
  22. Margot Sanger-Katz, “It’s Not Just You: Picking a Health Insurance Plan is Really Hard,” New York Times, Dec. 11, 2020.
  23. Centers for Medicare and Medicaid Services, Plan Year 2023 Qualified Health Plan Choice and Premiums in HealthCare.gov Marketplaces (CMS, Oct. 2022).
  24. Consumers Union, The Evidence Is Clear: Too Many Health Insurance Choices Can Impair, Not Help, Consumer Decision Making (CU, Nov. 2012); and Katherine Baicker, William J. Congdon, and Sendhil Mullainathan, “Health Insurance Coverage and Take-Up: Lessons from Behavioral Economics,” Milbank Quarterly 90, no. 1 (Mar. 2012): 107–34.
  25. Justin Giovannelli, Rachel Schwab, and Kevin Lucia, “State Efforts to Standardize Marketplace Health Plans Show How the Biden Administration Could Improve Value and Reduce Disparities,” To the Point (blog), Commonwealth Fund, July 28, 2021.
  26. Giovannelli, Schwab, and Lucia, “State Efforts to Standardize,” 2021.
  27. Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024, 88 Fed. Reg. 25740, 25855, 25922 (Apr. 27, 2023).
  28. John Holahan, Erik Wengle, and Claire O’Brien, Changes in Marketplace Premiums and Insurer Participation, 2022–2023 (Urban Institute, Apr. 2023).
  29. JoAnn Volk, Justin Giovannelli, and Kevin Lucia, “ACA ‘Bare Counties’: Policy Options to Ensure Access Must Address Longer-Term Stability and Competition,” To the Point (blog), Commonwealth Fund, Sept. 14, 2017.
  30. Mass. Gen. Laws ch. 176J, § 3(b) (2023).
  31. N.Y. Exec. Order No. 167 (July 21, 2017); and Wash. Rev. Code § 41.05.820 (2023).
  32. Jesse C. Baumgartner et al., How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care (Commonwealth Fund, Jan. 2020); and Dania Palanker and Nia Denise Gooding, What Four States Are Doing to Advance Health Equity in Marketplace Insurance Plans (Commonwealth Fund, Apr. 2022).
  33. Christine H. Monahan and Jalisa Clark, “Using Health Insurance Reform to Reduce Disparities in Diabetes Care,” To the Point (blog), Commonwealth Fund, Aug. 18, 2022.
  34. Monahan and Clark, “Using Health Insurance Reform,” 2022.
  35. National Committee for Quality Assurance, “NCQA’s Health Equity Accreditation Programs,” n.d. This total includes the D.C. marketplace, which adopted recommendations in which carriers agreed to obtain the National Committee for Quality Assurance’s Multicultural Health Care Distinction. “Year 1 (July 2021 to June 2022): D.C. Health Link Insurers’ Implementation of HBX Executive Board’s Resolution Adopting Recommendations from the HBX Executive Board’s Social Justice and Health Disparities Working Group,” presentation, D.C. Health Benefit Exchange Authority Board Social Justice and Health Disparities Working Group, July 13, 2022; and Maryland Health Benefit Exchange, “Final 2024 Letter to Issuers Seeking to Participate in Maryland Health Connection” letter, Mar. 29, 2023.
  36. Dania Palanker, Jalisa Clark, and Christine H. Monahan, “Improving Race and Ethnicity Data Collection: A First Step to Furthering Health Equity Through the State-Based Marketplaces,” To the Point (blog), Commonwealth Fund, June 9, 2022. This total includes the D.C. marketplace, which adopted recommendations in which carriers agreed to collect enrollees’ race, ethnicity, and language data. D.C. Health Benefit Exchange Authority Executive Board, “Resolution on Social Justice Health Disparities Working Group Recommendations,” adopted July 14, 2021.
  37. Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023, 87 Fed. Reg. 27208, 27242 (May 6, 2022).
  38. Rachel Schwab, Justin Giovannelli, and Kevin Lucia, “During the COVID-19 Crisis, State Health Insurance Marketplaces Are Working to Enroll the Uninsured,” To the Point (blog), Commonwealth Fund, May 19, 2020; and Caroline Hanson et al., “Health Insurance for People Younger Than Age 65: Expiration of Temporary Policies Projected to Reshuffle Coverage, 2023–33,” Health Affairs 42, no. 6 (June 2023): 742–52.
  39. KFF, “Marketplace Enrollment, 2014–2023,” n.d.; and KFF, “Distribution of Eligibility for ACA Health Coverage Among the Remaining Uninsured,” Timeframe: 2021, n.d.

Publication Details

Date

Contact

Rachel Schwab, Senior Research Associate, Center on Health Insurance Reforms, Georgetown University Health Policy Institute

[email protected]

Citation

Rachel Schwab et al., Policy Innovations in the Affordable Care Act Marketplaces (Commonwealth Fund, Nov. 2023). https://doi.org/10.26099/34x2-yj98