Health Policy Roundup: Recent Trends in Coverage Enrollment and Affordability

January 21, 2022

This event was Part II of the Alliance’s Health Policy Roundup and 2022 Forecast series.

Economic fallout and higher unemployment rates due to the pandemic have raised concerns about health insurance coverage enrollment and affordability in the U.S. Although the national uninsured rate remained mostly unchanged throughout the pandemic (at or around 1011%), many eligible Americans still do not have coverage. Moreover, even insured consumers are often underinsured, or have difficulty affording all of their health care costs, placing them at significant financial risk if they experience a serious or unexpected illness.

This event highlighted current trends in enrollment, premiums, and out-of-pocket costs in private insurance markets, and presented challenges and opportunities in getting eligible consumers enrolled in appropriate coverage. Panelists also explored coverage affordability and enrollment levers, including potential policy actions at federal and state levels, and how these issues intersect with other national policy conversations, COVID impact, and equitable benefit design.

For additional background information on insurance coverage, please Chapter 2 of the Alliance’s Health Policy Handbook.


  • Annette V. James, MAAA, FSA, FCA, Chairperson, Health Equity Work Group, American Academy of Actuaries
  • Kevin Patterson, MPA, MURP, Chief Executive Officer, Connect for Health Colorado
  • JoAnn Volk, M.A., Research Professor, Center on Health Insurance Reforms
  • Elizabeth Wroe, J.D., Principal, Leavitt Partners
  • Sarah J. Dash, MPH, President and CEO, Alliance for Health Policy (moderator)

This event was made possible with support from the Commonwealth Fund.

Presentation: Health Policy Roundup: Recent Trends in Coverage Enrollment and Affordability

Event Resources

Key Resources 

(listed chronologically, beginning with the most recent) 

“State Trends in Employer Premiums and Deductibles, 2010-2020.” The Commonwealth Fund. January 12, 2022. Available here. 

“HHS Notice of Benefit and Payment Parameters for 2023 Proposed Rule Fact Sheet.” Centers for Medicare and Medicaid Services. December 28, 2021. Available here 

“No Surprises Act Implementation: What to Expect in 2022.” Pollitz, K. Kaiser Family Foundation. December 10, 2021. Available here 

“Request for Information: Assessing How Common Practices and Methods Used by Health Actuaries and Health Plans Affect Health Disparities.” American Academy of Actuaries. October 29, 2021. Available here 

“How Insurance Marketplace Regulators Can Help Consumers Enroll in Better Coverage.” RAND Corporation. August 2, 2021. Available here. 

“Coverage and Affordability in the Private Insurance Market.” Alliance for Health Policy. July 9, 2019. Available here 

Additional Resources 

(listed chronologically, beginning with the most recent) 

“Findings About the Dual-Eligible Consumer Experience.” Arnold Ventures. January 12, 2022. Available here 

“How Medicare Advantage Plans Can Support the United States’ Reinvestment in Health.” Gilfillan, R., Berwick, D., Kronick, R. Health Affairs. January 10, 2022. Available here. 

“State “Easy Enrollment” Programs Gain Momentum, Lay Groundwork for Additional Efforts to Expand Coverage.” Schwab, R., Giovannelli, J., Lucia, K., Corlette, S. The Commonwealth Fund. August 3, 2021. Available here.  

“State Efforts to Standardize Marketplace Health Plans Show How the Biden Administration Could Improve Value and Reduce Disparities.” Giovannelli, J., Schwab, R., Lucia, K. The Commonwealth Fund. July 28, 2021. Available here.  

“As the Pandemic Eases, What is the State of Health Care Coverage and Affordability in the U.S.?” The Commonwealth Fund. July 16, 2021. Available here. 

“How States Can Build on the ACA to Improve Affordability and Lower Health Care Costs.” Center for American Progress. July 15, 2021. Available here. 

“Fixing the ACA’s Family Glitch.” Health Affairs. May 20, 2021. Available here. 

“Making Employer-Sponsored Insurance More Affordable.” Health Affairs. May 17, 2021. Available here. 

“Health Coverage by Race and Ethnicity, 2010-2019.” Kaiser Family Foundation. July 16, 2021. Available here 

“Changing the “Family Glitch” Would Make Health Coverage More Affordable for Many Families.” Urban Institute. May 11, 2021. Available here. 

“The Enrollment Coalition.” Leavitt Partners. 2021. Available here. 

“The Benefits and Limitations of State-Run Individual Market Reinsurance.” Giovannellli, J., Volk, J., Schwab, R., and Curran, E. The Commonwealth Fund. November 11, 2020. Available here. 

“Unpacking Colorado’s New Guidance on Transgender Health.” Keith,  K. The Commonwealth Fund. November 10, 2021. Available here. 

“State-Based Marketplaces Gear Up to Implement the American Rescue Plan.” Corlette, S. and Schwab, R. The Commonwealth Fund. April 20, 2021. Available here.  

“Updating the Essential Health Benefit Benchmark Plan: An Unexpected Path to Fill Coverage Gaps?” Corlette, S. and Ario, J. State Health and Value Strategies. September 11, 2020. Available here. 

“States Work to Make Individual Market Health Coverage More Affordable, but Long-Term Solutions Call for Federal Leadership.” Giovannelli, J., Volk, J., and Lucia, K. The Commonwealth Fund. January 15, 2020. Available here. 




Annette James, MAAA, FSA, FCA
NovaRest, Principal

Kevin Patterson, MPA, MURP
Connect for Colorado Health, Chief Executive Officer

JoAnn Volk, M.A.
Center on Health Insurance Reforms, Research Professor

Elizabeth Wroe
Leavitt Partners, Principal

Experts and Analysts

Thomas Barker, J.D.
Foley Hoag, Founder, Co-Chair, Medicaid and CHIP Payment and Access Commission (MACPAC)

Linda Blumberg, Ph.D.
Urban Institute, Institute Fellow

Kate Bundorf, Ph.D.
Sanford School of Public Policy and Duke Margolis Center for Health Policy, J. Alexander McMahon Professor of Health Policy and Management

James Capretta
American Enterprise Institute, Senior Fellow

Sara R. Collins, Ph.D.
The Commonwealth Fund, Vice President of Health Care Coverage and Access

Cynthia Cox, MPH
Kaiser Family Foundation, Vice President for the Program on the ACA

Philip Ellis, Ph.D., MPP
Ellis Health Policy, Inc., President

Edmund F. Haislmaier
The Heritage Foundation, Preston A. Wells, Jr. Senior Research Fellow

Mark Hall, J.D.
Wake Forest Law, Director of Health Law and Policy Program and Fred D. and Elizabeth L. Turnage Professor of Law

David Kendall
Third Way, Senior Fellow for Health and Fiscal Policy

Nadereh Pourat, Ph.D.
UCLA Fielding School of Public Health, Professor for Department of Health Policy and Management

Sara Rosenbaum, J.D.
George Washington University Milken Institute of Public Health, Harold and Jane Hirsh Professor of Health Law and Policy, Founding Chair


Jessica Farb
U.S. Government Accountability Office, Managing Director of Health Care

Christie Peters
HHS Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, Director, Division of Health Care Access and Coverage

Jeff Wu
Centers for Medicare and Medicaid Services, Deputy Director for Policy at the Center for Consumer Information and Insurance Oversight


Laura Colbert, MPH
Georgians for a Healthy Future, Executive Director

Paul Fronstin, Ph.D.
Employee Benefit Research Institute, Director of Health Research and Education Program

Julie Goon
Anthem, Senior Vice President of Public Affairs

Meg Murray
Association of Community Affiliated Plans, Chief Executive Officer

Jodi A. Ray, M.A.
Florida Covering Kids & Families, Director

Lori Shoaf
Blue Cross Blue Shield Association, Managing Director of Federal Relations

Joel White
Council for Affordable Health Coverage, President



This is an unedited transcript.