Five years after the passage of Obamacare, nearly half of the 17 insurance marketplaces set up by states are struggling financially. The Washington Post,
Most exchanges are independent or quasi-independent entities. For most of them, the main source of income is fees imposed on insurers, which typically are passed on to consumers. Because those fees are based on how many people have signed up, strong enrollment is critical to an exchange’s fiscal success.
But for the recently completed open enrollment period, signups for the state marketplaces rose a disappointing 12 percent, to 2.8 million people. That compared with a 61 percent increase for the federal exchange, to 8.8 million people, according to Avalere Health, a consulting firm. States with the smallest enrollment growth are among those facing the most daunting financial problems.