Breaking: HHS confirms ACA enrollment is at an all-time high: Over 31 million covered

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A month ago I noted that by my back-of-the-envelope math, total enrollment in ACA healthcare coverage had likely reached 30 million people, concluding that:

#ACA Enrollment Is At An All-Time High Right Now Almost Any Way You Slice It.

I based this on a rough comparison of ACA enrollment in 2016 (which saw the highest ACA Open Enrollment Period enrollment to date, with nearly 12.7 million people selecting Qualified Health Plans (QHPs) during the official OEP) versus the most recent data available as of spring 2021.

My rough math was as follows (spring 2016 / spring 2021):

  • Effectuated ACA exchange: 10.8 million / at least 10.7 million
  • Basic Health Plan (MN/NY only): 450,000 / 975,000
  • Special Enrollment Period: ~600,000 from 2/15 - 5/30 / likely ~1.6 million (same period)
  • Medicaid Expansion (newly eligible): 11.2 million / likely ~16 million
  • Medicaid Expansion (previously eligible): ~3 million / likely ~4 million
  • Off-Exchange ACA plans: ~4.1 million / at least 1.5 million (likely higher)

Add these all up and you get either:

  • Medicaid previously eligible included: ~30.15 million / ~32.3 million
  • Medicaid previously eligible not included: ~27.15 million / ~30.8 million

At the time I even knocked off a half a million just to err on the safe side, just in case...but even if you do that, either way, total ACA healthcare coverage enrollment is the highest it's been in history right now.

Well, guess what?

New HHS Data Show More Americans than Ever Have Health Coverage through the Affordable Care Act

  • 31 Million People Currently Enrolled in Marketplace or Medicaid Expansion

Today, the U.S. Department of Health and Human Services (HHS) released a new report that shows 31 million Americans have health coverage through the Affordable Care Act – a record. The report also shows that there have been reductions in uninsurance rates in every state in the country since the law’s coverage expansions took effect. People served by the health Marketplaces and Medicaid expansion have reached record highs.

The data shows those individuals currently enrolled in health coverage through the Health Insurance Marketplaces and Medicaid expansion under the ACA, including 11.3 million people enrolled in the ACA Marketplace plans as of February 2021 and 14.8 million newly-eligible people enrolled in Medicaid through the ACA’s expansion of eligibility to adults as of December 2020.

In retrospect, I should've realized that I lowballed the effectuated exchange enrollment for this year. That 10.7 million figure from last year represented a 93.5% retention rate; a similar rate out of the 12.0 million QHP selections during OEP this year would be at least 11.22 million. Sounds like it was higher yet, more like 94%.

It looks like I overshot on the Medicaid expansion side (I guessed 16 million vs. the 14.8 million actual)...except that the HHS figure is still only as of December, while my 16 million estimate is as of March or April. Given that Medicaid expansion has continued to grow a bit since December, it might actually be close to my 16M estimate by now. Then again, it might be starting to drop off again as the economy recovers.

In addition, there are one million people enrolled in the ACA’s Basic Health Program, and nearly four million previously-eligible adult Medicaid enrollees who gained coverage under expansion due to the ACA’s enhanced outreach, streamlined applications, and increased federal funding under the ACA. Today’s report shows the important role the ACA has played in providing coverage to millions of Americans nationwide.

The BHP figure was already known, and it sounds like I nailed it on the previously-eligible figure as well: "nearly 4 million."

The report also shows that between 2010 and 2016, the number of nonelderly uninsured adults decreased by 41 percent, falling from 48.2 million to 28.2 million. All 50 states and the District of Columbia have experienced reductions in their uninsured rates since the implementation of the ACA, with states that expanded Medicaid experiencing the largest reduction in their uninsured rate. California, Kentucky, New York, Oregon, Rhode Island, Washington, and West Virginia have reduced their uninsured rate by at least half from 2013 to 2019 through enrollment in Marketplace coverage and expansion of Medicaid to adult populations. To date, 37 states and the District of Columbia have expanded Medicaid to cover adults under the ACA.

HHS Secretary Xavier Becerra released the following statement on Twitter: “The historic numbers released today speak to the success of the Affordable Care Act and our country’s need for quality, affordable health care. The President’s American Rescue Plan was a leap forward, and we at HHS will continue to advance the fight for health security.”

“Health care coverage is life-changing for our communities and families. Thanks to the Affordable Care Act millions of Americans have been able to enroll in high-quality, affordable coverage through the Marketplaces and Medicaid expansion,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden-Harris Administration is working to strengthen these vital programs that have advanced health equity and improved health outcomes. With the implementation of the American Rescue Plan, which builds on the ACA, health coverage is more affordable and accessible than ever. As we rebuild from the health and economic impacts of the pandemic and work to address the disparities it has illuminated, we’ll protect and build on the ACA to ensure Americans can access the care they need.”

I believe this is the first major statement by newly-confirmed CMS Administrator Chiquita Brooks-LaSure, which seems appropriate to me.

Today’s report demonstrates the important role the ACA has played in helping Americans access and enroll in quality, affordable health coverage, especially during the COVID-19 crisis. With millions of Americans facing uncertainty and challenging circumstances throughout the pandemic, the Biden-Harris Administration opened HealthCare.gov for a Special Enrollment Period (SEP) to help Americans enroll in health insurance coverage. To date, more than 1 million new consumers have signed up for coverage through HealthCare.gov during the SEP since February 15. As new Marketplace consumers activate their health plan coverage, ACA related enrollment will continue to climb through the end of the SEP in August.

Keep in mind that a) the 1 million figure is only via HC.gov (around 30% of ACA exchange enrollments are via the other 14 states + DC, including large states like California, New York and Pennsylvania), and b) only runs through the beginning of May (the official tally as of 4/30 was 940,000, announced o May 6th, and the 1.0M figure was mentioned by President Biden just a few days later; my guess is the HC.gov figure is more like 1.2 million as of the end of May, and 1.6 million when you include all 50 states & DC).

CMS should be releasing an updated official SEP report running through the end of May early next week...in fact, I'm surprised it wasn't included with today's press release/announcement, though they might figure it's better to release it separately.

Consumers who need coverage through the Marketplace should visit HealthCare.gov by August 15 to complete an application, review their options, and, if eligible, enroll in coverage. Consumers can find local help at Localhelp.healthcare.gov or by calling the Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in 150 languages. The call is free.

HealthCare.gov can also direct eligible consumers to Medicaid in their state. Consumers can apply for Medicaid any time during the year.

The SEP is currently available to consumers in the 36 states with Marketplaces that use the HealthCare.gov platform in 2021. Consumers served by State-based Marketplaces that use their own platforms can check their state's website to find out more information on Special Enrollment Periods in their state.

To read the ASPE Issue Brief, visit here.

I'll be doing a deeper dive into the actual ASPE report in a separate entry.