Skip to main content
Robert Wood Johnson Foundation
  • Our Vision
    • Our Vision Overview
    • Why Health Equity
    • Focus Areas
    • Measuring RWJF Progress
  • Grants
    • Grants Overview
    • Active Funding Opportunities
    • Awarded Grants
    • Grantee Stories
    • Grant Process
    • Grantee Resources
  • Insights
    • Insights Overview
    • Blog
    • Our Research
    • Advocacy And Policy
  • About RWJF
    • About RWJF Overview
    • Our Guiding Principles
    • How We Work
    • Impact Investments
    • Staff And Trustees
    • Press Room
    • Careers
    • Contact Us
    • Accessibility Statement
Find A Grant
Global Search Dialog
    Robert Wood Johnson Foundation
    • Our Vision
      • Our Vision Overview
      • Why Health Equity
      • Focus Areas
      • Measuring RWJF Progress
    • Grants
      • Grants Overview
      • Active Funding Opportunities
      • Awarded Grants
      • Grantee Stories
      • Grant Process
      • Grantee Resources
    • Insights
      • Insights Overview
      • Blog
      • Our Research
      • Advocacy And Policy
    • About RWJF
      • About RWJF Overview
      • Our Guiding Principles
      • How We Work
      • Impact Investments
      • Staff And Trustees
      • Press Room
      • Careers
      • Contact Us
      • Accessibility Statement
    Find A Grant
    Global Search Dialog

      What's Behind 2018 and 2019 Marketplace Insurer Participation and Pricing Decisions?

      Brief Jan-01-2019 | Holahan J, Blumberg L, Wengle E, Elmendorf C | 2-min read
      1. Insights
      2. Our Research
      3. What's Behind 2018 and 2019 Marketplace Insurer Participation and Pricing Decisions?
      Download report
      A medical professional listens to a girl's heart using a stethoscope.

      ACA marketplaces gain stability in 2019 after turbulent 2018.

       

      The Issue

       

      Consumers using Affordable Care Act (ACA) marketplaces to assess 2019 health insurance options had more choices of insurers with generally modest premium increases—and even some decreases. This is a contrast to 2018 when several insurers left the marketplaces and premiums increased dramatically in most markets. Researchers conducted extensive interviews with marketplace insurers in 10 states (California, Florida, Georgia, Indiana, Maryland, Minnesota, Ohio, Virginia, Washington, and West Virginia) to prepare the analysis.

       

      Key Findings


       

      • Insurer participation declined in the 2018 plan year primarily because of policy changes made in 2017 as well as increased political uncertainty and the associated financial risks. Policy changes included the ending of direct funding of cost sharing subsidies, reduction in the length of the open enrollment period, and reduced funding for outreach and enrollment assistance. Efforts to repeal the ACA also were felt to discourage enrollment and thus insurer participation.
      • For the 2019 plan year insurers were increasingly willing to enter new markets, marking a substantial shift from 2018 when political uncertainty and policy changes drove sharp declines in participation.
      • Shifts between 2018 and 2019 show more plans offering narrow provider networks, an increasingly common strategy insurers use to contain costs and limit networks to high-performing providers. 
      • Many markets were also dominated by health maintenance organization products offered by Blue Cross Blue Shield affiliates and Medicaid insurers.

       

      Conclusion

      Researchers found that insurer participation in the marketplaces began to rebound in 2019, following decreases in participation in many areas in 2018. Some insurers expanded their geographic footprint in states in which they already participated, and others expanded to new states. Insurers were generally satisfied with the outcomes of their 2018 decisions.

      Following many dramatic marketplace premium increases in 2018, premium growth in 2019 tended to be modest, and even negative in some areas. The 2018 increases were largely attributable to insurers incorporating the costs associated with cost-sharing reductions into their premiums and to the tremendous uncertainty created by other regulatory changes and the political debate surrounding reform. Insurers appear to be readjusting premium growth in 2019 to account for 2018 overestimates.

       

      About the Urban Institute

      The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. For more information, visit www.urban.org. More information specific to the Urban Institute’s Health Policy Center, its staff, and its recent research can be found at www.healthpolicycenter.org.

      Related Content

      Brief
      RWJF Promise Story- Childhood Obesity- Nashville, TN, March, 2011. Re/Storing Nashville: Faith-Based Initiatives Save-A-Lot 2400 Clarksville Pike

      How Have Workers Fared Under the ACA?

      Concerns regarding negative effects on employment and employer-sponsored insurance did not come to fruition according to an Urban Institute analysis of federal data.

      1-min read

      Healthcare Coverage and Access
      • About this Grant

      Subscribe to receive Funding Alerts & more

      Explore the latest in reflection and research from subject matter experts at RWJF and our wide network of partners.

      Email address already subscribed. Please check your inbox to manage your subscriptions.

      Subscribed!

      Thank you. You are now subscribed.

      Tell us what type of content you want to receive.

      Be informed with our twice a month newsletter updating you with relevant news and research around a Culture of Health, as well as the latest funding opportunities.

      Get funded by RWJF: Receive notifications when new funding opportunities are released.

      Receive monthly updates on RWJF-sponsored research that informs many robust health policy debates on Capitol Hill, covering topics like health equity, improving access to quality healthcare, equitable housing, and more.

      Shop talk for researchers. This monthly newsletter covers research news and opportunities from the Robert Wood Johnson Foundation.

      Communications expedite action. Get periodic research and expert insights on the best ways to communicate so we can spread what works.

      Sometimes we have news, announcements or opportunities that don't quite fit the subscription parameters above. If you're interested, we'll send you this information under "There's more...". *If you've indicated you are an EU resident, we will only send these communications if you intentionally check this box.

      Which profession or pursuit best describes you?

      Area(s) Of Interest

      Unsubscribe

      Stop receiving all emails from RWJF

      This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
      • CONTACT RWJF

        50 College Road East
        Princeton, NJ 08540-6614

         

        US Toll Free: (877) 843-7953

        International: +1 (609) 627-6000

      • MANAGE YOUR GRANTS

        MyRWJF Login

        • Facebook
        • LinkedIn
        • YouTube
        • Instagram

      • Our Vision
        • Our Vision Overview
        • Why Health Equity
        • Focus Areas
        • Measuring RWJF Progress
      • Grants
        • Grants Overview
        • Active Funding Opportunities
        • Awarded Grants
        • Grantee Stories
        • Grant Process
        • Grantee Resources
      • Insights
        • Insights Overview
        • Blog
        • Our Research
        • Advocacy And Policy
      • About RWJF
        • About RWJF Overview
        • Our Guiding Principles
        • How We Work
        • Impact Investments
        • Staff And Trustees
        • Press Room
        • Careers
        • Contact Us
        • Accessibility Statement

      ©2001- 

      Robert Wood Johnson Foundation. All Rights Reserved. 

       

      • Manage Email
      • Privacy Statement
      • Terms and Conditions