NEJM October 18, 2017
As the U.S. Congress debates the future of the Affordable Care Act (ACA), the public has increasingly called for bipartisan solutions on health care reform. An immediate challenge is stabilizing the ACA marketplace, where 10.3 million people enroll in coverage. Given that certain areas of the country have few insurers participating in the marketplace — because of high enrollee costs, uncertainty over cost-sharing–reduction payments from the federal government, and the expiration of protections for insurers such as reinsurance and risk corridors (which limit how much they can gain or lose through risk sharing) — policies that encourage insurers to enter and stay in the marketplace are needed.
Largely missing from the current debate are proposals to improve the affordability of...
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