Affordability of Marketplace Coverage

A man fills in a form at the reception area of a Department of Children and Family Serices office.

The challenge of affordability to health insurance enrollment in the marketplace and state options to lower consumer costs are outlined in this report from the Urban Institute.

The Issue:

The most frequent reason that uninsured adults who visited a health insurance marketplace gave for not enrolling in marketplace coverage was affordability. Researchers found that even with subsidies, consumers still believed that health coverage was unaffordable. However, several states appeared to overcome this obstacle through unique approaches.

Key Findings

  • Minnesota uses a Medicaid waiver to provide more affordable coverage outside the marketplace to consumers with incomes up to 200 percent of the federal poverty level.

  • Vermont supplements federal subsidies inside the marketplace to improve affordability for consumers with incomes up to 300 percent of the federal poverty level.


Several states offer promising examples of innovative strategies for overcoming the perceived unaffordability obstacle.

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 Follow the Urban Institute on Twitter at or Facebook More information specific to the Urban Institute’s Health Policy Center, its staff, and its recent research can be found at