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The Choice: Return to a Broken Health Insurance Market or Move Toward Market Stability

As Congress weighs the repeal and replacement of the Affordable Care Act (ACA), it’s important to recognize that earlier this year the ACA health insurance marketplaces were projected to become increasingly stable over 2017 and 2018. Uncertainty about funding for the marketplaces—not their failure—is the primary driver of the premium increases and insurer dropouts we see today.

The ACA has made it easier and more affordable for people to buy health insurance on their own. Prior to the ACA:

  • Most people who tried to buy plans on the individual market could not find affordable plans that met their needs and instead went uninsured.
  • In 2010, an estimated 9 million people who had tried to buy a plan on their own over the prior three years were turned down, charged a higher price, or had a health problem excluded because of their health status.
  • Many who had health plans and developed health problems were at risk of having their coverage cancelled.
  • Pregnancy in most states was a preexisting condition and coverage for maternity care was rare.
  • Many health plans provided bare bones coverage where a health emergency could trigger serious financial problems and even bankruptcy for individuals and families.

State and federal policy makers have tools to make necessary improvements to the marketplaces. But it is important that we build on the historic gains achieved so far through reform. Learn more about ACA marketplace stability and follow #ACARepealDebate on Twitter.

Publication Details



"The Choice: Return to a Broken Health Insurance Market or Move Toward Market Stability," To the Point, The Commonwealth Fund, June 12, 2017.