Six findings:
1. Research found that, among other factors, persistent inflation and uncertainty regarding whether the ACA’s enhanced premium tax credits would be extended were the primary drivers of the increased premiums.
2. Between 2019 and 2022, average benchmark premiums decreased by an average of 2.2 percent annually.
3. Benchmark premiums varied considerably across states and rating regions, largely influenced by insurer competitions.
4. Premiums were an average of $128 higher in regions where only one payer offered ACA plans than in those where five or more insurers offered plans.
5. Competition was less robust in small cities and rural areas, which typically only have two or three insurers offering Marketplace plans.
6. States that expanded Medicaid eligibility requirements saw smaller premium increases.
