ACA Enrollment Hits 20.4M ─ And Counting

A record 20 million Americans signed up for marketplace health insurance, and that number is expected to grow.

Affordable Care Act (ACA) signups have blown up since open enrollment began on December 15th, marking the third year of increasing sign ups for ACA under the Biden Administration.

Signups have already surpassed last year’s numbers by 4 million and more are expected as the January 16th deadline approaches. Some states have also extended the open enrollment deadline through the end of January. Roughly 3.7 million of these signups, representing about one-fifth of the total, are new members.

KFF Health News surmised that much of this high enrollment comes from the disenrollment of many consumers from Medicaid programs. During the COVID-19 pandemic, states were not allowed to disenroll people from Medicaid, but since April 2023, disenrollments have been allowed to resume. As a result, over 14 million  people were disenrolled from their Medicaid plan last year.

In the midst of the Iowa Caucus when Americans are carefully watching to select a Republican nominee, access to healthcare is a big issue on the table. Back in November of last year, former President Donald Trump revived his push to roll back the ACA, also known as Obamacare. At the 2022 midterm elections, the calls to eliminate the law failed and were abandoned by Republicans, but Trump could bring it back in 2024.

Meanwhile, the Biden Administration has argued for the law and the coverage it has provided to millions of Americans. An increase in consumer outreach from the Biden Administration has also played a part in new signups.

A press release from HHS services explained how the administration's use of ‘navigators’ also helped to increase signups:

“For this past enrollment cycle, the administration issued almost $100 million in Navigator Awards, allowing organizations to hire staff who are trained to help consumers find affordable, comprehensive health coverage. Navigators, as they are known, have been key to helping consumers enroll in quality health insurance plans in every Marketplace state.”

Enhanced subsidies for the program have also driven enrollment this season. With the Biden Administration adding enhanced subsidies in the American Rescue Plan Act and the Inflation Reduction Act, coverage has become more affordable for enrollees.

KFF Health News reported that 45 states saw an increase in their ACA enrollment compared to last year. Some Republican states specifically saw an uptick in signups, including Louisiana and West Virginia; both states saw a 63% increase in enrollment year-over-year.

KFF also pointed out this unusual mid-year growth in market enrollment. Unlike previous years, 2023 saw a boom in mid-year growth from April 2023 to September 2023, outside of the open enrollment window. Usually, the number of people leaving the program exceeds the number of people signing up for it, mainly due to limited qualification opportunities. 2021 was one other exception where mid-growth was apparent, when Biden first rolled out the enhanced subsidies in the American Rescue Plan Act and most state-based marketplaces saw more opportunities for mid-year enrollment.