In this brief, we spoke with stakeholders in six states to assess the impact of Medicaid insurers increasing dominance in the ACA marketplaces. Overall, stakeholders said there are no longer major distinctions between Medicaid and traditional commercial insurers in the marketplace. Commercial insurers have adopted cost-containment strategies employed by Medicaid insurers including narrowing networks for more favorable provider payment rates. Medicaid insurers have started adopting commercial insurers’ practices, such as paying broker commissions, engaging in more marketing and advertising, and slowly increasing payments to providers. In doing so, stakeholders credit Medicaid insurers for increasing choice and affordability in the individual health insurance market.