An estimated 9.4 million fewer Americans reported problems paying medical bills 18 months after the opening of the Health Insurance Marketplace, according to the Urban Institute’s latest Health Reform Monitoring Survey. The share of adults under 65 who reported problems paying family medical bills over the past year fell 4.7 percentage points over the period, to 17.3%. Medicaid expansion states saw a 5.1-point decline and non-expansion states a 4.2-point decline. Respondents who were uninsured, low income or had more significant health needs were more likely to report problems. The report compares survey responses in September 2013, just before the first Marketplace open enrollment period, with responses in March 2015, just after the second open enrollment period ended.