As a consequence of the ACA's reformed nongroup insurance market, some have raised concerns about short-term "rate shock" an increase in premiums as a result of enhanced consumer protections and more risk-sharing compared with the pre-reform market as well as longer-term instability due to adverse selection, the phenomenon by which particular insurance plans or markets attract an enrollment with higher than average health care risks. While the ACA includes strategies intended to mitigate these effects, some states are introducing additional strategies to strengthen the protections. This paper explores policies designed to address these concerns being implemented in 11 states.