With a decade of experience, mature Affordable Care Act (ACA) marketplaces continue to undergo significant changes amidst record enrollment levels. State activity has ramped up and similar themes have emerged. For example, an increasing number of states have either established or are considering operating their own exchange. This panel will explore the history of state-run exchanges, the current renewed interest in them and the reasons for that renewed interest, as well as other dynamic market changes and their impact on enrollment trends. By attending this session, you will: Comprehend the historical dynamics in the ACA's first decade which will shape the future Understand the 2024 premium landscape and what we can infer about future years Have a strong grasp on how the ACA's second decade will differ from the first from an actuarial perspective