What Explains 2018's Marketplace Enrollment Rates?

A doctor talks with a patient in his waiting room.

Interviews look at factors that influenced 2018 marketplace enrollment.


The Issue

Fifteen states saw higher enrollment in 2018 compared to the previous year despite greatly reduced federal support for enrolling people in health insurance policies offered through the Affordable Care Act marketplaces. Researchers interviewed key stakeholders in five states—Rhode Island, Washington, New York, West Virginia and Louisiana—that experienced either an enrollment increase or decrease.

Key Findings

Factors influencing enrollment include:

  • Price of marketplace plans versus off-marketplace plans and size of premium tax credits, which was in turn influenced by “silver loading.”

  • Amount of advertising by state governments and insurers.

  • Use of social media, which may have attracted young and healthy consumers.

  • Tone of news coverage, which was more positive when state officials encouraged people to enroll in marketplace coverage.

  • Length of states’ open enrollment periods, which some states opted not to shorten.


Report authors offer a look ahead to 2019 concerns for marketplace enrollment, including the extension of less-comprehensive short-term plans to nearly one year, the absence of navigators in some service areas, and the repeal of the individual mandate.

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. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.