States Seek Greater Control, Cost-Savings by Converting to State-Based Marketplaces


Coworkers talking in office.

More states now want to control their Affordable Care Act marketplace.

The Issue

Eleven states and the District of Columbia currently operate their own health insurance marketplace eligibility and enrollment websites under the Affordable Care Act (ACA), but that number is slated to grow. Several states are contemplating a transition from the federally-facilitated marketplace (FFM)——to a state-based marketplace (SBM). To assess decision-making regarding the benefits and risks of transitioning to an SBM, researchers reviewed states that have publicly declared intention or interest in transitioning.

Key Findings

The primary factors driving states to switch from the platform to a full SBM are:

  • the prospect of costs savings,

  • an improved consumer experience, and

  • regaining more autonomy over their insurance markets.


Through speaking with state officials, insurers and consumer advocates, the authors found that transitioning to an SBM was viewed as a natural next step in many state’s broader visions to reduce the number of uninsured and make health care more affordable. However, this transition is no small feat and comes with several risks. States looking to transition should know their specific goals, set realistic expectations, allow for sufficient lead-time, and engage stakeholders early and often to make for a smooth transition.

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.

About the Georgetown Center on Health Insurance Reforms

The Center on Health Insurance Reforms (CHIR), based at Georgetown University’s McCourt School of Public Policy, is composed of a team of nationally recognized experts on private health insurance and health reform. We work regularly with a multidisciplinary group of faculty and staff dedicated to conducting research on issues related to health policy and health services. CHIR faculty and staff study health insurance underwriting, marketing and products, as well as the complex and developing relationship between state and federal rules governing the health insurance marketplace.

CHIR provides policy expertise and technical assistance to federal and state policy-makers, regulators and stakeholders seeking a reformed and sustainable insurance marketplace in which all consumers have access to affordable and adequate coverage.