In this paper, we explore Affordable Care Act (ACA) Marketplace premiums at the state and rating region levels, focusing on the changes between 2021 and 2022, although we do include data from prior years. In 2022, the ACA Marketplaces entered their ninth year of operation, and premiums have fallen in a number of places around the country despite the unknowns of the pandemic and the economic recovery. The national average benchmark premium fell again in 2022, following decreases in the prior three years. This decline is striking because it contrasts with a premium increase of 4 percent in the employer-sponsored insurance market over the same period. However, the nationwide average belies the variation in premiums both across and within states. We find that variations in the amount of the increase in benchmark premiums seemed to be mostly affected by two factors. First, higher unemployment rates, which we used as a proxy for the severity of COVID-19 outbreaks in the rating region, led to higher premium increases (we assumed more COVID-19 cases led to more job losses). Second, an increase in the number of insurers in 2022 had a strong negative effect on benchmark premium increases.
This report was corrected April 13, 2022. On page 4, the fifth row in table 1 shows data for Arizona. In a previous version, the row was mislabeled as Alaska.