News Release

Issue Brief Examines the Experiences of Five States During Year Two of Affordable Care Act Coverage Expansions

A new issue brief from the Kaiser Family Foundation draws upon 40 in-person interviews conducted with a variety of stakeholders to assess the recent experiences of five states during the second year of coverage expansions under the Affordable Care Act (ACA).  The interviews took place in three states — Colorado, Kentucky and Washington — that have State-based Marketplaces, and have adopted the Medicaid expansion, and in two states — Utah and Virginia — that rely on the Federally-facilitated Marketplace, and have not expanded Medicaid.

In addition to providing insight into how enrollment in coverage under the ACA is going, and the extent to which the problems that plagued the initial open enrollment period have been resolved, the brief offers detailed, on-the-ground views of how Marketplaces are evolving and impacting consumer choices, the financial stability of State-based Marketplaces, the extent to which newly insured individuals are accessing care; and what the costs of care have been for Medicaid expansion adults.

Key findings include:

  • Most major enrollment systems issues have been resolved.  States that expanded Medicaid continued to experience enrollment growth, and marketplace enrollment goals were met or surpassed in four of the five states, although affordability remains a challenge.
  • In all five states, efforts are underway to increase health insurance and health care literacy among newly insured individuals.
  • The three states that expanded Medicaid report that per enrollee costs of care for Medicaid expansion enrollees have been lower than anticipated and expansion enrollees generally have been able to get care, although there are access challenges for certain specialties and behavioral health services.
  • Access to care for individuals enrolled in QHPs varies based on their choice of plan, with some individuals who selected lower cost plans with limited networks experiencing challenges getting care.

Looking ahead, the states are focused on a range of priorities, including continued improvements to enrollment systems and efforts to enhance access to care and care coordination.  Moreover, in Colorado and Washington, there is significant pressure on the Marketplaces to achieve financial sustainability; in Utah and Virginia, debate around the Medicaid expansion and the outcome of the King v. Burwell Supreme Court case remain the most significant issues; and, in Kentucky, the upcoming gubernatorial election could have significant implications for implementation given the opposition to the ACA among potential candidates.

For the full report, Year Two of the ACA Coverage Expansions: On-the-Ground Experiences from Five States, as well as the Foundation’s additional work on the Affordable Care Act, visit

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The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.