The Massachusetts exchange remains robust despite the Trump administration's decision to immediately cease cost-sharing reduction payments to insurers, but major premium increases that resulted from the change led tens of thousands of members to switch their coverage. Off-exchange commercial enrollment is flat, but it could receive a boost if efforts to ensure that workers enroll in employer-sponsored, rather than publicly subsidized, coverage are successful. National for-profit carrier UnitedHealthcare is making gains in a state traditionally dominated by regional, nonprofit insurers. The state utilizes a state-based health insurance exchange called Massachusetts Health Connector and has had its own individual mandate since 2006.

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