ACA Marketplace Open Enrollment Numbers Reveal the Impact of State-Level Policy and Operational Choices on Performance

By Rachel Schwab and Sabrina Corlette

During the last open enrollment period, the Affordable Care Act’s (ACA) marketplaces faced a number of headwinds; federal policy changes, including the removal of the individual mandate penalty and the expansion of products sold outside the regulated individual market, were predicted to curb marketplace signups. Despite these challenges, the federal government has drastically reduced funding for marketplace advertising and enrollment assistance. Given myriad obstacles to enrollment efforts, it came as no surprise that overall marketplace plan selections dropped slightly this year. But a deeper dive into enrollment trends reveals that most state-based marketplaces outperformed the federally facilitated marketplace, highlighting the unique authorities of state-run exchanges.

In a new post for the Commonwealth Fund’s To the Point, CHIR’s Rachel Schwab and Sabrina Corlette unpack data from the recent open enrollment period to see how the ACA’s marketplaces performed during a turbulent time. While plan selections on the federally facilitated marketplace fell almost 4 percent, overall plan selections on state-based marketplaces stayed steady. The authors find that certain policy and operational decisions, such as opting for a state-run technology platform and extending the enrollment period, were associated with better results. These findings, along with the success stories of a number of innovative state marketing campaigns, illustrate how state-level efforts to bolster enrollment paid off.

You can compare marketplace data and read the full piece here.

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