During the open enrollment period for the 2018 plan year, approximately 11.8 million people enrolled in marketplace coverage and 74 million people enrolled in Medicaid, bringing the United States’ uninsured rate to 12.2¹. States continue to identify and pursue strategies to further reduce the numbers of uninsured, to make coverage more affordable for consumers and to improve access to care. In the absence of federal legislation to stabilize the individual market, states are seeking options to strengthen their marketplaces and maintain coverage gains.

In recent months, several proposals have been introduced at both the federal and state levels that would permit people above Medicaid eligibility levels to “buy in” to Medicaid or would leverage the Medicaid program to strengthen coverage across the individual market and Medicaid. These state initiatives include the following (see Appendix for more detail)...