The Affordable Care Act (ACA) ushered in a range of consumer protections designed to make it easier for individuals to obtain affordable, adequate health insurance in the individual market. In many states, however, individual market consumers have faced increasingly limited plan choices, relatively narrow provider networks, and rising unsubsidized premiums. In the past year, policy decisions made by Congress and the Trump administration have exacerbated trends. In this brief, we examine brokers’ evolving role in the individual market, consumer purchasing decisions, and brokers’ observations about how the market and consumers are responding to recent federal policy adjustments to the ACA. Overall, alternative coverage options are being marketed to people who are ineligible for subsidies and looking for less expensive coverage. With the loss of the individual mandate, many brokers expect these markets will grow, particularly for short-term plans and association health plans, in the wake of federal regulations designed to expand their sale. At the same time, the marketing of other alternative products to brokers, including health care sharing ministries and direct primary care arrangements, is increasing. Consequently, the individual health insurance market is expected to become smaller and sicker.
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