Marketplace Issues/Stability

More than 10 million Americans rely on the Health Insurance Marketplaces for health coverage.

The Health Insurance Marketplaces have become a major source of health care coverage, and millions of low-income individuals rely on the marketplaces to access subsidies to lower the cost of their premiums and cost-sharing. However, the marketplaces in some regions have struggled to stabilize, with volatility in health plan participation and double-digit premium increases. While all markets will have at least one health plan offering coverage in 2018, the AHA supports solutions that will bring longer-term stability to this important source of coverage.

A number of factors have contributed to marketplace instability. In some cases, demographic factors, such as a small population base and disproportionately unhealthy population, can make a market unattractive to health plans. The federal and state regulatory structure also plays a critical role.

Most recently, uncertainty regarding federal payments for the cost-sharing reduction subsidies has led to both health plan exits and higher premiums for the plans that will be sold. Other policy challenges include issues related to appropriate reimbursement, particularly as they relate to the reinsurance and risk-adjustment programs, and uncertainty regarding enforcement of the individual mandate.

The AHA is committed to protecting this vital source of coverage, and we urge Congress, the Administration and states to take steps to stabilize the marketplaces.

Read on for more information on the marketplaces and specific actions that can be taken to ensure their stability.