24 Million Consumers Choose ACA Coverage, Enrollment Still Open

CMS has reported a historic milestone for the 2025 Marketplace Open Enrollment Period, with 23.6 million consumers selecting affordable health care plans through the Affordable Care Act (ACA) marketplaces.¹

Record numbers enroll in Affordable Care Act (ACA) coverage as open enrollment continues through January 15, 2025. | Image credit: AKDIM_DESIGN - stock.adobe.com

Owing to expanded financial assistance and the Inflation Reduction Act (IRA), many consumers now have access to quality coverage for as low as $10 per month. As open enrollment continues through January 15, 2025, millions more can secure health insurance.

“The Affordable Care Act health insurance marketplace and reforms have proven to be successful and critically important for millions of Americans and their families,” HHS Secretary Xavier Becerra said in a statement. “Every American should have access to quality, affordable health care — and thanks to the ACA, they do. The Affordable Care Act now stands along with Medicare, Medicaid, and Social Security as one of the most consequential social programs in the history of our nation.”

However, despite significant progress in expanding health insurance coverage under the ACA, millions of Americans still face critical gaps in access to and affordability of health care.² Moreover, with the GOP controlling the House and Senate and President-elect Donald Trump returning to office, this year could bring significant changes to the ACA.

What Will Happen If Enhanced Subsidies Expire?

In 2021, temporary subsidies were passed as part of the American Rescue Plan Act (ARPA), which included 2 years of enhanced subsidies.³ The IRA, which passed in 2022, then extended these subsidies for an additional 3 years, set to expire after 2025. Millions of enrollees have relied on these subsidies, which increase the amount the of financial help available to those with already eligible for assistance under the ACA and newly expand subsidies to middle-income people (with incomes over 4 times the poverty level, equalling $103,280 for a family of 3 in 2024).

If these subsidies expire, almost all ACA marketplace enrollees will experience steep increases in premium payments in 2026. However, these subsidies also have a steep impact on taxpayers, with the Congressional Budget Office projecting that a permanent extension of the subsidies would cost $335 billion over the next 10 years.

Despite previous opposition, some Republican members of Congress who had previously tried to repeal the ACA are beginning to come around to extending subsidies that allow more Americans to buy individual coverage, as the cost of health insurance continues to rise.⁴

It remains uncertain what Trump’s second term will signal for the future of enhanced subsidies, because he has yet to reveal a health care plan.

Since the implementation of enhanced subsidies, an analysis by KFF finds the following³:

• Since 2020, plan enrollment among low-income individuals—those earning up to 2.5 times the federal poverty level—has surged by 115%.
• Subsidies have reduced premium payments by an average of 44%, or $705 annually, for enrollees receiving tax credits.
• If the enhanced subsidies expire at the end of 2025 as scheduled, enrollees face the prospect of substantial premium increases, with costs doubling or more for subsidized enrollees in 12 states relying on Healthcare.gov.

“We can’t lose sight of what’s behind our tremendous, record-setting progress: Millions of individuals and families who now have a critical connection to the lifeline of health care coverage,” CMS Administrator Chiquita Brooks-LaSure said in a statement.¹ “To the millions more who may still need coverage: Don’t delay. Help is still available, including tax credits that have made coverage more accessible by reducing the barrier posed by high costs.”

References

1. Nearly 24 million consumers have selected affordable health coverage in ACA Marketplace, with time left to enroll. ACA. News release. January 8, 2025. https://www.cms.gov/newsroom/press-releases/nearly-24-million-consumers-have-selected-affordable-health-coverage-aca-marketplace-time-left#:~:text=CMS%20reports%20that%2023.6%20million,the%202021%20Open%20Enrollment%20Period

2. Grossi G. Despite record ACA enrollment, report reveals underinsured Americans are in crisis. AJMC. November 21, 2024. Accessed January 8, 2025. https://www.ajmc.com/view/despite-record-aca-enrollment-report-reveals-underinsured-americans-are-in-crisis

3. Ortaliza J, Cord A, McGough M, et al. Inflation Reduction Act health insurance subsidies: what is their impact and what would happen if they expire? KFF. July 26, 2024. Accessed January 8, 2025. https://www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/

4. Japsen B. Why Republicans are warming to extending Obamacare subsidies? Forbes. January 6, 2025. Accessed January 8, 2025. https://www.forbes.com/sites/brucejapsen/2025/01/05/why-republicans-are-warming-to-extending-obamacare-subsidies/