Technological innovation has always been at the center of the Affordable Care Act (ACA) Marketplaces and has never been more important than it is now. Changes brought on by the coronavirus pandemic have clearly illustrated a critical need to expand outreach and provide coverage to millions of people who have lost their employer-based insurance and may be best served by Medicaid or Marketplace coverage. Technology is one part of meeting this challenge, and the ACA Marketplaces have made important technological gains that can help do so.

This policy brief explores the evolution of the Marketplaces from a technology perspective, drawing from interviews conducted with state Marketplace leaders, technology companies, and consumer advocates. Much of what happened in the ACA’s first decade was driven by technology, including the development of two separate but interrelated tracks: the Federally Facilitated Marketplace (FFM) track and the State-based Marketplace (SBM) track, each of which has continued to evolve and improve in different ways. As we begin the ACA’s second decade, it is a good time to consider what the FFM and the SBMs can learn from each other to expand enrollment and improve the ACA coverage system.