ACA Unified Rate Review Template (URRT) Market Trends Over Time

In recent years, there have been substantial external forces that have impacted the individual and small group Affordable Care Act (ACA) markets. These forces have ranged from the COVID-19 pandemic, to policy changes increasing individual market premium subsidies, developing new pathways for ICHRAs (individual coverage HRAs), large inflationary pressures, Medicaid re-determination, and more. How have issuers adapted their participation and pricing to this changing landscape and, consequently, impacted market size and dynamics? To answer this question, we examined the CMS required Unified Rate Review Template (URRT) which includes a breakdown on plan rate changes, financial reporting, and the various components of premiums. The URRT allows us to explore variations in retention, risk adjustment, premiums, and claim costs by plan.

The intent of this brief is to share trends on the financial health of markets and issuers over time, how issuer participation, market size, and plan offerings have evolved, the driver of revenue changes due to these external forces, and what those trends could mean for future years.