Under the Affordable Care Act (ACA), all insurers that offer fully insured health insurance must pay an annual fee - the so-called health insurance tax (HIT). The fees are based on insurance premiums and insurers' tax is roughly proportional to their market share. The tax was designed to help fund the federal and state marketplace exchanges. In 2018, Congress approved a one-year moratorium on collecting insurer taxes for 2019. The moratorium is set to lapse in 2020 and insurers now face an estimated $16 billion fee in 2020. To recoup the cost of the tax, insurers are expected to increase premiums.