The number of people signing up for health insurance through the Affordable Care Act marketplaces this quarter hit a record high for the third consecutive year, with the latest data released by the Biden administration on Wednesday showing more than 21 million people selected a plan between Nov. 1 and mid-January.
According to past enrollment data released by KFF, a health policy research organization, total enrollment during the latest open enrollment period increased by 30% from a year ago. This is also an 87% increase from registrations in 2020, which was the lowest registration total since the market was established and operated in 2014, its first year.
“For decades, when it came to the federal programs we could rely on to keep Americans covered, three were always top of mind — Medicare, Medicaid and Social Security, but now it’s clear we need to add a fourth – Affordable Care takes action,” Health and Human Services Secretary Xavier Becerra said in a statement. “Once again, a record number of Americans have signed up for affordable health insurance through the Affordable Care Act’s marketplaces, and now they and their families can have peace of mind with coverage.”
The latest data reflects people using the federal HealthCare.gov platform to select coverage for 2024 in 32 states, with the enrollment deadline last week. Also included are plan options for 18 states and the District of Columbia to operate their own markets, some of which have enrollment deadlines at the end of the month, meaning overall enrollment could still grow.
Officials said the numbers include 5 million new enrollees and more than 16 million people covered by ACA plans in 2023.
Some of the largest enrollment increases associated with the health care reform law known as Obamacare occurred in states that have not yet expanded Medicaid to more low-income people. From 2023 to 2024, Texas will see the largest increase in the number of insured people, with nearly 1.1 million people, followed by Florida, which will increase the number of insured people by more than 986,000 people. West Virginia, which expanded Medicaid, had the largest enrollment increase, at 80%.
“Marketplace coverage is important for people in states with incomes below 138 percent of the poverty level,” said Sara Collins, vice president for health care coverage and capturing and tracking health system performance at The Commonwealth Fund. “This reflects the lack of Medicaid expansion in these states.”
A KFF analysis noted that enrollment in ACA health plans has increased year over year under the Biden administration. Meanwhile, under former President Donald Trump, total enrollment fell 10% to 11.4 million in 2020, compared with 12.7 million in 2016, the year Trump took office.
Cynthia Cox, co-author of the KFF report and director of the organization’s ACA program, said the increase in demand is in line with trends over the past few years, thanks in part to increased subsidies provided by the American Rescue Plan Act and the Lower Inflation Act. Reduced cost of marketplace plan premiums. The Biden administration is also emphasizing outreach efforts, including investing more than $98 million during the 2023 open enrollment period to support navigators who can help people find health insurance.
Meanwhile, Cox said the biggest factor that could lead to a sharp rise in enrollment in 2024 is the millions of people who lost health insurance as continuation of Medicaid ended last year.
Her analysis noted that enrollment in the individual health insurance market, including the ACA market, grew by 5.7% between April and September 2023, with enrollment growing by about 1 million.
“When (continuous enrollment) ends in April 2023, we could see it correspond to the increase in market enrollment in the middle of last year, even before the open enrollment period began,” Cox said. “It’s really unusual because in a normal year you would see the market shrink during these months and this year we’re actually seeing the market grow.”
Collins said the enhanced subsidies are set to expire at the end of 2025, and continued enrollment growth in future years will largely depend on whether lawmakers choose to preserve such benefits.
“If you don’t renew these subsidies, then I think you’re going to see some of the gains we’ve made diminish,” Colin said.
The 2024 presidential election may also have an impact on future enrollment. Former President Donald Trump, the Republican front-runner, has again expressed his desire to “replace” Obamacare – a goal the Republican Party was unable to achieve during his previous term. The previous Trump administration also cut back on outreach and other initiatives aimed at helping people get into school.