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The number of states operating state-based health insurance marketplaces has been slowly but steadily rising over the last five years. When the Affordable Care Act (ACA) first required states to choose between providing a state-based marketplace (SBM) or operating through the federally facilitated marketplace (FFM), also known as HealthCare.gov, 14 states and Washington, DC chose to operate SBMs – roughly 30% of the country.   Today, there are 20 states (and Washington, DC) operating SBMs, with another state – Oregon – in the process of transitioning. By the time we get to the end of 2026, approximately 43% of the country will be operating through a state-based marketplace. Figure 1 illustrates the change in the number of marketplace types over time.   Figure 1: Chart comparing the number of states (and Washington, DC) operating on the FFM, as SBMs, and as SBMs on the federal platform (SBM-FPs) over time. Note: Oregon is not included as a full SBM in 2026 because its SBM is not live at the time of this post.  The recent growth in the number of SBMs isn’t coincidental. SBMs offer states enhanced autonomy and flexibility – both qualities that have proven critical in insurance marketplace success in recent years. In this piece, we provide a quick background on SBMs, list the states that are currently operating them, and share some of the reasons states are increasingly choosing to switch to SBMs. We also outline some of the proven, best-in-class tools GetInsured offers to states pursuing the […]