SALT LAKE CITY — States and the federal government share a vital economic relationship. This data summary, the thirteenth in a series on state and federal economic linkages from the Kem C. Gardner Policy Institute, presents the Utah-federal government nexus for the Affordable Care Act (ACA) Health Insurance Marketplace.
“The ACA, signed into law in 2010, established the framework for health insurance marketplaces nationwide,” said Melanie Beagley, senior health research analyst at the Gardner Institute. “The Marketplace and the accompanying tax credits help make health insurance coverage affordable for Utahns who do not have access to health insurance coverage through work or public health care coverage programs. These include small business owners, their employees, and self-employed workers.”
Key findings from the summary include the following:
Enrollment Rate – 11.8% of Utahns are enrolled in the Marketplace, ranking Utah 4th highest among all U.S. states in 2025. This is higher than Utah’s Medicaid enrollment rate of 9.7% as of February 2025.
Federal Funding - The federal government funds up to an estimated $1.7 billion in premium tax credits for Utahns purchasing health insurance through the Marketplace in 2024. This funding supports approximately 421,900 Utahns who purchase health insurance through the Marketplace.
Premium Tax Credits - Approximately 96% of Utah Marketplace enrollees receive a premium tax credit in 2025. The average tax credit is $463, resulting in an average monthly premium of $70 for Utahns with a Marketplace plan.
Demographic Insights - Children under 18 comprise the largest share of Marketplace enrollees in Utah, accounting for 27.9% of total enrollees. This represents the highest share of enrollees under 18 among all states.
Small Business Impact - Only 40.8% of Utahns working for small businesses are in establishments that offer health insurance, the 6th lowest among U.S. states. This compares to an average of 53% nationwide.
Enhanced Affordability - The introduction of enhanced premium tax credits through the American Rescue Plan (ARPA) doubled Utah’s Marketplace enrollment, particularly among individuals with incomes below 200% of the Federal Poverty Level (FPL). Enrollment among individuals with incomes below 200% FPL increased from 98,100 in 2020 to nearly 270,000 in 2025.
Location - Most Marketplace enrollees reside along the Wasatch Front and in Washington County. When viewed as a share of each county’s total population, Marketplace enrollment is highest in Wayne County (19.4%), Rich County (17.9%), and Juab County (17.2%).
The complete data summary is available online.
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