Affordability of Marketplace Coverage: Challenges to Enrollment and State Options to Lower Consumer Costs

The end of the ACA’s first open enrollment period has seen better-than-expected participation and a significant drop in the number of uninsured, particularly in states that expanded Medicaid. However, many eligible uninsured have not yet signed up. This paper focuses on one factor that has emerged as a challenge to marketplace enrollment: namely, consumers’ perception that, even with federal subsidies, Qualified Health Plans are not affordable. The paper begins by analyzing how this factor played out during the open enrollment season for 2014, and then describes promising practices implemented by particular states to improve the affordability of coverage.