Celebrating 10 Years of ACA Marketplaces, Biden-Harris Administration Releases Historic Enrollment Data

Under President Biden, more than 45 million people have coverage thanks to the Affordable Care Act and key actions taken under the Administration to strengthen the law.

Today, the US Department of Health and Human Services (HHS) released four new reports showing that President Biden’s efforts to strengthen the Affordable Care Act (ACA) are linked to historic gains in insurance coverage medical of Americans. Today’s announcements include a report from the Centers for Medicare and Medicaid Services (CMS) showing that more than 21 million consumers automatically selected or re-enrolled in health insurance coverage through HealthCare.gov and state markets during the open enrollment period (OEP) of 2024. . Three reports from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) highlight current enrollment trends, enrollment trends broken down by race and ethnicity, and how ACA markets have evolved and strengthened during the first ten years. ASPE’s analysis shows that more than 45 million people now have coverage thanks to the expansion of Medicaid and the Affordable Care Acts Marketplaces.

On the 10-year anniversary of the ACA’s marketplaces, HHS is releasing data that shows how much it has reshaped what health care looks like for so many Americans. Marketplaces have become a pillar of American society, a guaranteed place where people can find affordable, quality coverage, HHS Secretary Xavier Becerra said. Thanks to President Bidens leadership, more than 21 million Americans now have health insurance through the Affordable Care Act marketplaces, an all-time high, with millions of families saving hundreds of dollars each month. At HHS, we will continue to do everything we can to ensure that more people have access to affordable, high-quality health care and the peace of mind that comes with it.

As we look back and celebrate the historic achievements of the Affordable Care Act, the law continues to fulfill its purpose of providing affordable, quality health care coverage to Americans. Gone are the days when being female was considered a pre-existing condition or sick children could be denied health insurance. Today, more than 100 million Americans have coverage through the Marketplace or Medicaid, thanks (in part) to increased affordability thanks to the Inflation Reduction Act, said Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services. And they didn’t stop. Our commitment to strengthening the ACA and increasing access to comprehensive and affordable health coverage has never been stronger.

The Biden-Harris administration has taken unprecedented action to make health insurance available and affordable for everyone. National estimates show that most consumers qualified for $0 premiums or are saving at least $800 a year on their premium, underscoring the importance of the American Rescue Plan and the Inflation Reduction Act. Overall, four out of five HealthCare.gov customers were able to select from health coverage options that cost $10 or less per month. In addition, the Biden-Harris administration issued nearly $100 million for organizations to hire staff to help consumers find comprehensive and affordable health coverage. Navigators, as they’re known, have been key to helping consumers in every state.

Key points from today’s reports include the following.

2024: Total market plan selections during the 2024 open enrollment period

  • During the 2024 Open Enrollment Period (OEP), more than 21.4 million consumers automatically selected or re-enrolled in health insurance coverage through the HealthCare.gov marketplaces and state marketplaces ( SBM).
  • 5.1 million more consumers signed up for coverage during the 2024 OEP compared to the 2023 OEP, a 31% increase.
  • In the HealthCare.gov Marketplaces, 16.4 million consumers selected plans during the 2024 OEP between November 1, 2023 and January 16, 2024.
  • Among the 19 SBMs, 5.1 million consumers selected plans during OEP 2024 from November 1, 2023 through the end of their respective OEPs.
  • 5.2 million people signed up for coverage for the first time, up 41% from 3.7 million in the previous OEP.
  • Nationally, 44% of consumers selected a plan for $10 or less per month after APTC during OEP 2024.

2024: Coverage under the Affordable Care Act: Current enrollment trends and state estimates

  • 18.6 million people have coverage thanks to the ACA’s Medicaid expansion.
  • Among coverage groups, a total of 45 million Americans are enrolled in ACA-related coverage, the highest total on record. This represents 14.1 million more people enrolled than in 2021 (a 46% increase) and 32.5 million more people enrolled than in 2014 (a 258% increase, or more than triple).
  • The survey results indicate that all 50 states and the District of Columbia have seen substantial reductions in their uninsured rates since 2013, the last year before the ACA was implemented.

2015-2023: Summary of ASPE market registrations by race and ethnicity

  • The policies of the Biden-Harris Administration, such as expanded and enhanced premium tax credits under the American Rescue Plan and the Inflation Reduction Act and increased market disclosure and funding for Navigator likely they contributed to gains in health coverage, especially among low-income populations and communities of color.
  • Black Americans and Latinos continued to enroll in health coverage through the Marketplace at high rates. An estimated 1.7 million blacks and 3.4 million Latinos enrolled in Marketplace plans in HealthCare.gov states during the 2023 open enrollment period, representing an increase in enrollment from 95% and 103%, respectively, from 2020.
  • The number of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) enrollees increased by 14 percent between 2020 and 2023.
  • More than half of black, Latino and Asian-American enrollees select silver plans with cost-sharing reductions, making it the most frequently selected plan. These reduced cost-sharing plans allow patients below certain incomes to pay less out-of-pocket each time they receive medical services.

2014-2024: How ACA markets have evolved in 10 years

  • The ACA substantially transformed health insurance by creating health insurance marketplaces where consumers can purchase private comprehensive coverage that meets consumer protection and coverage standards.
  • The number of issuers participating in Marketplaces has grown in recent years, offering nearly all Marketplace consumers (96%) a choice of plan offerings from at least three different issuers. This increased competition in the market has helped to make premiums more affordable for both members and taxpayers. By 2024, 210 health insurance carriers are participating in the Marketplaces.
  • Between 2013 and the third quarter of 2023, the uninsured rate for all ages fell from 14.4% to 7.7%. Since 2013, the rate of uninsured children has decreased from 6.5% to 3.4% in 2023.
  • The ACA brought in key consumer protections, such as preventing consumers from being denied or charged more for coverage because of pre-existing conditions, age and gender.
    • For example, before the ACA, 92 percent of popular plans used gender qualification. A woman could pay up to 81 percent more for the same plan than a man of the same age, even without the plan covering maternity care.
  • Before the ACA, health plans also often limited the benefits they covered. In 2011, 62 percent of individual market enrollees did not have coverage for maternity services, 34 percent did not have coverage for substance use disorder services, 18 percent did not have coverage for services of mental health and nine percent of enrollees did not have prescription drug coverage.

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