Policy Wonks Parse the Curious Case of Declining State-Based Marketplace Enrollment

With nearly all the 2023 open enrollment period data now tallied, it appears that something curious is happening in states that run their own Affordable Care Act exchanges: Enrollment levels are on track to decline compared to 2022. That trend follows years in which state-based marketplaces (SBMs) outperformed states using the HealthCare.gov platform in terms of year-over-year enrollment growth, and it comes as HealthCare.gov states are reporting a significant signup surge compared to 2022.

Health policy experts tell AIS Health, a division of MMIT, that there are likely multiple factors causing the reversal of fortunes between HealthCare.gov and SBM enrollment. But in an important takeaway for health insurers that operate in the exchanges, they say the trend could indicate that the “addressable market” in certain states is reaching its saturation point.

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Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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