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The Affordable Care Act (ACA) was implemented in the U.S. in March of 2010. The policy is designed to make insurance accessible to all residents of the U.S. that qualify. The ACA also implemented changes to Medicaid, Medicare, and other public health insurance schemes. Historically, there has been an increase in insurance premiums from year-to-year. However, recent data indicates that premium costs are on the decline for many states. As of 2018-2019 the state of Tennessee has seen the greatest percentage decrease in insurance premium costs under the ACA. Premium prices decreased by percent during that time in Tennessee. Vermont, however, has seen the largest increase in premiums with a percent increase seen from 2018 to 2019.