Turmoil in the Individual Insurance Market — Where It Came From and How to Fix It

NEJM July 27, 2017
Henry J. Aaron, Ph.D., Matthew Fiedler, Ph.D., Paul B. Ginsburg, Ph.D., Loren Adler, B.A., and Alice M. Rivlin, Ph.D.

In recent weeks, some health insurers have announced that they will not offer individual market coverage in 2018, while others have requested sizable premium increases. In response to this news, President Donald Trump has pronounced the individual market structure created by the Affordable Care Act (ACA) “dead.” Similarly, House Speaker Paul Ryan (R-WI) has claimed that the market is experiencing a “death spiral” reflecting fundamental flaws in the ACA’s design. These claims misdiagnose the situation. The ACA’s individual market structure — though not perfect — is sound and has succeeded in greatly expanding coverage. As 2017 began, the market was poised to leave behind the growing pains of the past few years. Then the President and Congress acted to create...

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