Issue Briefs , Reports | Jan 19, 2021

The ACA in Maryland: A Case Study in Successful Bipartisan Innovation

The Affordable Care Act (ACA) sets up a structure with key roles for both federal and state policymakers. Federal regulations and subsidies are interwoven into a health insurance system that remains primarily a state responsibility, with additional options for state roles. It is not surprising, then, that different states have seen different market outcomes in terms of costs and enrollment. Maryland fully embraced the ACA from the start. From establishing a state-based marketplace to a temporary Maryland supplemental reinsurance program, Maryland made every effort to ensure the ACA’s success in the state. This case study describes the measures taken by the state to improve affordability and coverage, identifies unique program design features, and discusses their bipartisan appeal as experienced in Maryland. Maryland’s efforts can serve as a helpful framework for other similarly situated states seeking to address pressing health coverage affordability issues.