This report provides a detailed review of the commercial health insurance industry’s financial results in 2019 and evaluates changes in the market’s expense structure and enrollment relative to prior years. The report also discusses emerging financial trends and outlook for the commercial health insurance markets, based on year-end 2020 statutory financial statements. The analytics in this report were developed based on a combination of medical loss ratio (MLR) data submitted to the Centers for Medicare and Medicaid Services (CMS), insurance marketplace enrollment reports, and statutory filings. The analysis also discusses the financial impacts of the COVID-19 pandemic.