In 2016, Medicare and Medicaid accounted for nearly 60 percent of health care revenues reported by the nation’s five largest commercial health insurance companies, according to a Health Affairs study supported by the Commonwealth Fund and led by Cathy Schoen of the New York Academy of Medicine. But some of these companies have recently made decisions to leave the ACA marketplaces in several states, even as they continue to enroll people in public coverage. The authors suggest policymakers consider requiring insurers to offer marketplace coverage if they participate in Medicaid and Medicare within the same region.