The health insurance marketplaces, established under the Affordable Care Act (ACA), rely upon a system of managed competition to ensure access, affordability and consumer choice in the individual and small group markets. This approach has effectively expanded coverage to millions of Americans,1 the vast majority of whom receive federal subsidies to reduce premiums and, in some cases, other out-of-pocket costs.2 Health care affordability remains a concern for many Americans, however, and proponents of a “public option” argue that offering a government-run health plan in the marketplaces will improve affordability and access by promoting competition and choice.
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