ACA Enrollment Hits Record Levels

Enrollment in Affordable Care Act (ACA) marketplace plans has reached record levels, and the Biden administration is using those numbers to push for continuation of enhanced subsidies that have lowered premiums for the plans.

CMS announced in March 2022 on the 12th anniversary of the healthcare reform law that enrollment had reached 14.5 million, a 21% increase over last year. About 10 million people enrolled through the federal government’s exchange, Healthcare.gov and the rest through the exchanges that 18 states have set up on their own. Some of the enrollment deadlines for those state-based exchanges are later than the Jan. 15 deadline for Healthcare.gov, so the final tally for the number of Americans in ACA marketplaces is likely to increase.

As a candidate, President Joe Biden said he would build on the ACA rather than push for Medicare for all. The administration has framed the enrollment figures as validation of that approach.

Katie Keith, J.D., M.P.H., an ACA expert who holds positions at the Georgetown University Law Center in Washington, D.C., and writes about the law for Health Affairs,
noted in a blog post for the journal that enrollment was especially strong in several states that have not expanded their Medicaid programs under the ACA, including Florida, Georgia, North Carolina and Texas.

Keith and the administration pointed to increased subsidies as one of the main reasons for the increased enrollment. About one-third of the people who signed up through Healthcare.gov for coverage selected a plan with a monthly premium of $10 or less. The Biden administration wants the enhanced subsidies to continue and estimates that 3.4 million people will lose coverage through the marketplace plans if they aren’t.

The administration has issued new rules that will apply to the 2023 coverage year. Keith said changes include requirements that seek to standardize benefit design and raise network adequacy standards.