The Health Insurance Marketplaces established by the Affordable Care Act (ACA) have become an important source of coverage for more than 10 million Americans, many of whom receive federal subsidies to reduce the cost of coverage. However, many of the Marketplaces are exhibiting signs of instability, including volatility in plan participation and significant year-over-year premium rate increases. If instability is not addressed, insurers may choose not to sell in a Marketplace, leaving consumers without options for coverage and without the ability to access federal premium and cost-sharing subsidies.

While many of the factors contributing to Marketplace instability could be addressed through changes in federal policy, states also have levers to stabilize their Marketplaces and ensure health coverage is available. This paper identifies a suite of state-level solutions to these issues. Given the unique characteristics of each state, there is no single option that would work for all states, and all the options come with implementation hurdles. Among other considerations, the paper discusses which solutions may be more or less appropriate based on a state’s characteristics.

Click here to read the full AHA paper.