News Center for Health Economics & Policy Health Equity

Center supports research on changes in Health Insurance Marketplace conditions from 2014-22

Written by Kim Furlow, communications manager at the Institute for Public Health


Center for Health Economics and Policy researchers have published a new policy brief that shows changes in Health Insurance Marketplace participation from 2014 through 2022. Center faculty and staff conducted this research under a cooperative agreement with the Federal Office of Rural Health Policy, which funded the effort through the Rural Policy Research Institute (RUPRI)’s Center for Rural Policy Analysis at the University of Iowa.

According to the policy brief, since the 2014 implementation of health insurance marketplaces, non-metropolitan counties have had less marketplace participation than metropolitan counties. However, since 2018, there has been steady growth in the number of competing issuers in both metropolitan and non-metropolitan marketplaces.

“While this study is national in focus, the findings are important to understanding the range of choices available to residents seeking health insurance coverage,” said Timothy McBride, PhD, MS, co-director of the Center for Health Economics & Policy and brief co-author.

The brief’s lead author, Eliot Jost, MBA, MPH, statistical data analyst for the center, says the brief describes the changes in health insurance marketplace plan issuers over the 2014-2022 period, with an emphasis on the variation across metro and non-metro areas, and outlines changes in economic and policy conditions that may have had an influence on issuer participation over time.

Our research is of service to public health and policy practitioners seeking to understand the extent to which issuer participation in health insurance marketplaces has fluctuated over time by region and rurality. This is important because competition in the health insurance marketplaces can function to drive affordability and quality of plans.

Eliot Jost. lead author

The brief shows that marketplace participation trends differ by census region (West, Midwest, South, Northeast) and rural classification. While marketplace participation by issuers initially lagged in the South and Midwest, by 2022, differences in marketplace participation across census regions by rurality were narrower.

Among non-metropolitan counties, marketplace participation is greater in states that have expanded Medicaid as compared to states that have not.  However, this difference appears to be closing as of 2022. “Broadly, our findings suggest that differences in issuer participation in the health insurance marketplaces are narrowing,” said Jost.

 “This work expands our understanding of the ACA marketplaces, filling out the recent history on choices available across the U.S.,” said McBride. “This fits well with the mission of our center to disseminate important research to the policy and research communities.”

Read the brief: Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22 by Eliot Jost, MBA, MPH; Abigail Barker, PhD; Leah Kemper, MPH; Fred Ullrich; Keith Mueller, PhD; Timothy McBride, PhD | August 2022