It has been five years since the passage of the Patient Protection and Affordable Care Act (PPACA) and the creation of the health insurance exchange marketplaces. The health insurance marketplace was conceived as a way for individuals without public or employer-sponsored health care coverage to purchase affordable health insurance. The health insurance marketplaces opened enrollment for the first time in 2013, with coverage beginning in 2014. The 2014 health insurance marketplace was characterized by software glitches, extensions to the open enrollment period, and concerns about whether the demographics of enrollees would allow the marketplace to remain commercially viable.

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