Increased Competition in ACA Individual Health Insurance Markets Since 2021

The commercial health insurance market in the U.S. remains highly concentrated across different coverage types. However, the individual market, largely composed of ACA Marketplace plans, has seen increased insurer participation and competition since the introduction of enhanced premium tax credits in 2021. From 2020 to 2023, the market share of the largest insurer in each state's individual market decreased from 60% to 53%, correlating with increased enrollment driven by these tax credits. In contrast, fully insured employer-sponsored health insurance markets have experienced a decline in competition over the past decade. The analysis covers enrollment and competition trends from 2013 to 2023 nationally and by state, highlighting shifting dynamics within commercial health insurance markets. This data is accessible through the Peterson-KFF Health System Tracker, a resource dedicated to monitoring health system performance.