What is the ACA
Health Insurance Marketplace?

The Health Insurance Marketplace is a platform created by the Affordable Care Act (ACA) to provide health insurance plans to individuals, families, and small businesses. The Marketplace aims to extend health insurance coverage to millions of uninsured Americans. While many states offer their own marketplaces, the federal government manages an exchange that is open to residents of other states.

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Despite the benefits of the Marketplace, there are several problems in the ACA marketplaces, which have been highlighted by Aetna’s pullback in participation. Premiums are projected to rise much more rapidly next year than they did this year, and in almost a third of counties, marketplace enrollees may have a choice of only one plan next year. This will affect about 19% of enrollees, primarily in rural areas, and is a substantial increase from this year.

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However, the vast majority of enrollees will be insulated from premium increases by government subsidies if they enroll in one of the lowest-cost plans available in their area. The administration is calling for Congress to increase financial assistance for those who receive partial or no subsidies and cannot afford coverage.

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While the marketplaces face real challenges, they are a modest part of the overall insurance system. More than 13 times the number of people enrolled in the marketplaces, around 150 million, have coverage through employers. Additionally, 66 million people are in Medicaid, and 55 million are in Medicare. Many Americans with employer coverage believe they are affected by premium increases in the marketplaces when they are not.

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The marketplaces fulfill a vital role in the health system by replacing the previously broken non-group insurance market where many people could not get coverage if they were sick. The ACA has covered 20 million more people and reformed insurance rules. However, recent talk of "Obamacare failing" seems to conflate the marketplaces with the ACA overall.

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Ultimately, marketplace enrollment needs to grow. There are ways to boost enrollment and interest more insurers in participating, if Congress and a new administration choose to work together on such improvements. The issues in the ACA marketplace are real problems that need to be addressed through greater enrollment and policy changes.