Analyzing Different Enrollment Outcomes in Select States That Used the Federally Facilitated Marketplace in 2014

A counselor meets with a substance abuse patient and her baby daughter.

Researchers analyze why two pairs of states in the federally facilitated marketplace (FFM) had very different enrollment rates in 2014, comparing North Carolina with South Carolina, and Wisconsin with Ohio.

The Issue:

Demographics, uninsurance rates and FFM premium rates did not appear to explain the enrollment differences in the paired case study states.

Key Findings

  • Lack of support for the ACA appears to play a role in marketplace enrollment in the two states that did less well relative to enrollment projections.

  • Coordinated strategy and coalition of diverse stakeholders appeared to improve FFM enrollment outcomes in the more successful states.

  • Focused messaging and outreach efforts on Medicaid enrollment appeared to affect marketplace enrollment rates.


Researchers also offer several cross-cutting observations about outreach and enrollment strategies that sources in all four study states identified as significant.

About the Grantee:

The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic and governance problems facing the nation. For more information, visit