Skip to main content


Nearly Half of ACA Enrollment in 2018 Came Through BCBS Plans

By Melanie Blackman  
   June 02, 2020

An Urban Institute analysis found marketplace enrollees chose name-brand insurance over Medicaid, but Medicaid enrollment is still growing.

Almost half of the Affordable Care Act (ACA) marketplace enrollment in 2018 was issued by Blue Cross Blue Shield companies, according to a report released by the Urban Institute Monday.

The study analyzed the insurance offerings on the marketplace and found that there has also been an increase in Medicaid enrollment in the recent years.

While Medicaid insurers "have increasingly offered plans with the lowest silver-level marketplace premiums," the report found that Blue Cross-affiliated insurers made up the majority of enrollment type. But Medicaid enrollment is still growing.

  • In 2016, Blue Cross-affiliated insurers made up 42%, while Medicaid made up 15%
  • In 2017, Blue Cross-affiliated insurers made up 50%, while Medicaid made up 26%
  • In 2018, Blue Cross-affiliated insurers made up 47%, while Medicaid made up 27%

Study authors John Holahan, Caroline Elmendorf, and Erik Wengle analyzed the most recent "federally facilitated marketplace files" to collect data from the 39 states that are part of the federal platform, during the 2016, 2017, and 2018 calendar years.

They attributed the growth in Medicaid enrollment due to the decline in enrollment through national and regional insurers. However, this trend could change in the coming years due to the reemergence of insurers to the ACA marketplace.

"There was an increase in the number of insurers participating in 2019 and 2020 and there are now reports of national insurers re-entering marketplaces in 2021," the study concludes. "Whether these insurers will regain previous levels of enrollment, e.g., 2016, will be interesting to observe."

Related: 3 Ways COVID-19 Has Changed the Insurance Landscape

The ongoing coronavirus disease 2019 (COVID-19) is also likely to impact the insurance marketplace dynamics going forward.

Due to the pandemic, the unemployment rate rose to 14.7% in April, which caused a jump in health insurance coverage by Medicaid, as it emerges a "default insurance plan for many of the newly unemployed," according to Kaiser Health News.

Editor's note: This story was updated on June 4, 2020.

Melanie Blackman is the strategy editor at HealthLeaders, a Simplify Compliance brand.

Photo credit: CALDWELL, IDAHO - NOVEMBER 4, 2017: website under the trump administration / Editorial Credit: txking /

Get the latest on healthcare leadership in your inbox.