Insurers Remaining in Affordable Care Act Markets Prepare for Continued Uncertainty in 2018, 2019

Insurers implemented significant premium increases and offered fewer plan choices in 2018 in response to federal policy uncertainty.

The Issue

Through structured interviews with 10 insurance companies participating in the Affordable Care Act’s (ACA) marketplaces in 28 states and the District of Columbia, researchers examined insurers’ participation and pricing strategies for the 2018 and 2019 plan years.  

Key Findings

Interviewees shared:

  • The uncertainty about the rollback of the mandate requiring most individuals to purchase health insurance or pay a penalty increased premiums in some areas in 2018.

  • Further premium increases are expected in 2019 since the tax law passed at the end of 2017 and set the penalty to $0 beginning next year.

  • Concern that restoring cost-sharing reimbursements could result in confusion and big price hikes for consumers receiving premium subsidies in the ACA’s marketplaces.

  • Concern about implications of the expansion of short-term health plans and association health plans for the pricing in and stability of ACA markets. However, some reported that they would consider selling these products in order to retain healthy enrollees and remain competitive.


Most insurers in the study remain committed to participating in the individual market, but acknowledged that their commitment is being tested by policies that undermine the stability of the individual market.

About the authors

Georgetown University’s Health Policy Institute—Center on Health Insurance Reforms

The Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute is a nonpartisan, expert team of faculty and staff dedicated to conducting research on the complex and developing relationship between state and federal oversight of the health insurance marketplace.

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