87m adults were uninsured or underinsured in 2018 survey says as health care costs rise more americans are being pushed into inadequate health insurance plans that cause them to put off care. These expansions in coverage and access to care have coincided with a marked slowdown in per enrollee health care cost growth a slowdown to which the aca has contributed although it is certainly not the sole cause as shown in figure 3 per enrollee spending growth since 2010 has been slower than over the previous decade in private insurance medicare and medicaid. For 2014 16 states and washington dc opted for state run health insurance exchanges seven states established state federal partnerships and 27 states opted for the federal exchange although most states are still following the same model they used in 2014 there have been a few changes in the ensuing three years. In order to determine the best and worst states for health care wallethub compared the 50 states and the district of columbia across three key dimensions 1 cost 2 access and 3 outcomes we evaluated those dimensions using 43 relevant metrics which are listed below with their corresponding weights. Health insurance exchanges in the united states expand insurance coverage while allowing insurers to compete in cost efficient ways and help them to comply with consumer protection laws exchanges are not themselves insurers so they do not bear risk themselves but they do determine which insurance companies participate in the exchange
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