The federal government operates the Marketplace, available at, for most states. ... The Health Insurance Marketplace (also known as the “Marketplace” or “exchange”) provides health plan shopping and enrollment services through websites, call centers, and in-person help. is a health insurance exchange website operated under the United States federal government under the provisions of the Patient Protection and Affordable Care Act(PPACA, often referred to simply as 'ACA' or 'Obamacare'), which currently serves the residents of the U.S. states which have opted not to create their own state exchanges. The exchange facilitates the sale of private health insurance plans to residents of the United States and offers subsidies to those who earn between one and four times the federal poverty line, but not to those earning less than 100% of the federal poverty line.The website also assists those persons who are eligible to sign up for Medicaid, and has a separate marketplace for small businesses.

U.S. Health Care History, Problems & Solutions

2009 - Passage of the ACA

The debate over healthcare became especially vociferous in the early 21st Century. Democratic President Barak Obama introduced the Patient Protection and Affordable Care Act (ACA) in July 2009. The Act was based upon the healthcare program passed previously in Massachusetts by a Republican Governor and initially developed by a conservative think tank, The Heritage Foundation.

The Massachusetts Plan included:

A requirement that every resident obtain a minimum level of insurance

Free healthcare for those under less than 150% of the federal poverty level

A mandate that every employer with more than ten employees provides health care insurance

The Act became law in 2010, with votes along political party lines (all Republican members of the House of Representatives voted against the bill). A significant element in the selling of the Act to the public was the President’s promise: “If you like your private health insurance plan, you can keep your plan. Period.”

Provisions of the Act included new regulations such as new minimum coverage requirements (required coverage for pre-existing conditions, for example). As a consequence, many of the existing insurance plans for individual purchases did not meet minimum standards. Some insurance providers subsequently left different markets or raised premiums substantially.

While the ACA added millions of Americans to the insured rolls, it has been less effective in cutting the increasing cost of healthcare for the average citizen. According to the Congressional Budget Office, the average premium paid by a family or a single person more than doubled between 2001 and 2014, a rate exceeding growth in per capita income. Employers reacted to the increase in either cutting plan benefits or raising premiums, deductibles, and co-pays on employer-provided insurance (the Milliman Medical Index calculated that the average cost of annual health care for a family of four was $25,826 in 2016).

Opponents of the ACA assert that there is “overwhelming evidence that Obamacare caused premiums to increase substantially.” On the other hand, proponents claim that the ACA has been moderating premium rates that would have occurred without the Act. Brookings Instituteresearchers Loren Adler and Paul Ginsberg found that individual premiums were 10-21% under the premium projections before that Act.

Over the last six years of Obama’s term, Republicans attempted more than fifty times to repeal the Act. With the election of a Republican President in 2016, Republicans have repeatedly vowed to “repeal and replace” the Act during the first 100 days of the new President’s term. The question is what, if anything, will replace the ACA?