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State-based exchanges saw slight gain in ACA enrollment

States that partially or fully operate their own exchanges saw a 0.2% increase in Affordable Care Act plan enrollment over the previous year, while those states that relied entirely on the federal marketplace saw signups decline by 5.3%, according to data issued by the National Academy of State Health Policy. Overall, the number of Americans who enrolled for 2018 coverage dropped 3.7% to around 11.8 million as increases in state-based exchanges failed to offset losses on the federal marketplace, suggesting that the Trump administration's decision to slash ACA outreach and end cost-sharing reduction payments hurt enrollment.

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