The Affordable Care Act (ACA) Marketplaces have nearly tripled their enrollment in their first decade of operation, from eight million people in 2014 to 21.4 million in 2024. At the national level, the ACA has helped cut the uninsured rate nearly in half through a combination of Medicaid expansion, Marketplace enrollment and other initiatives. However, this national success masks wide variation among the states, from a 2.4% uninsured rate in Massachusetts to a 16.6% uninsured rate in Texas.
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