Administrative Burden

Administrative Burden

Policymaking by Other Means

Pamela Herd, Donald P. Moynihan

The ACA was designed with the assumption that states would run their own exchanges. The Department of Health and Human Services (HHS) expected that only eight states would participate in the federal marketplace. 2 Instead, only sixteen states chose to run their own exchanges, seven more partnering with the federal government, leaving 59 percent of the uninsured living in states that did not run their own exchange.

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