In the U.S. health care system, the individual healthcare insurance marketplace has always been something of an afterthought. Most Americans of working age receive coverage through their employer. Older Americans and those with disabilities typically get benefits from Medicare. Fewer than one in ten Americans purchase coverage directly from statewide individual marketplaces, established through the Affordable Care Act, or purchase unsubsidized plans outside these markets. Nevertheless, this represents tens of millions of individuals who depend on the quality and choice of the products in the individual market.