State by State Breakout: Florida breaks 4.0M, Texas adds 1.0M, WV up 79% & much more!

As promised, here's my full state-by-state breakout of the latest 2024 ACA Open Enrollment Period "Snapshot" report as we head into the final week of enrollment in most states.

As I noted earlier today:

Here's an overview of the year over year comparison. I had to adjust for the missing day (thru 12/23 instead of 12/24 last year). I've also had to adjust for the fact that Virginia moved from the federal exchange to its own platform this year:

I'll break out the hard numbers in a separate blog entry, but it's important to note again that the top line number, 20.35 million Open Enrollment Period Plan Selections, only runs through December 23rd and it also doesn't include the roughly 1.3 million Basic Health Plan program enrollees in New York or Minnesota.

This means that the actual total announced today is over 21.65 million enrollees nationally, and is still missing between 23 - 39 days of enrollees depending on the state.

Here's what that state by state breakout looks like (click image for higher-res version), and there's a lot going on here; see you below the spreadsheet...

Remember, I've had to adjust for the missing day this year (thru 12/23 instead of 12/24) for an apples to apples comparison. With that in mind:

  • Again, overall enrollment is up 33% year over year nationally
  • NEW enrollment is up around 31% vs. the same point last year, while renewing enrollees are up over 40%. Much of this is due to the ongoing Medicaid Unwinding process; over 1.2 million Americans shifted from Medicaid coverage to ACA exchange plans from April - September 2023; since they were already in the system I presume they still count as renewing enrollees, although honestly it doesn't really matter since both numbers are impressive.
  • Federal exchange (HealthCare.Gov) enrollment is up 40% when you adjust for the fact that Virginia moved from the federal exchange to its own state-based exchange this year.
  • State-based exchange enrollment is up 14% (again, after adjusting for Virginia moving off of
  • Medicaid expansion state enrollment is up 24%, but enrollment in the 10 remaining non-expansion states is up a whopping 42%...again, largely due to the Medicaid Unwinding population I'm sure.
  • There's not much of a gap between expansion & non-expansion if you limit it to the federal exchange states, however: up 36% vs. 42%.

OK, now that the above the fold numbers are out of the way, let's break it out at the state by state levels:

  • EVERY STATE except for Maine & DC are running ahead of last year, ranging from +2.8% in Hawaii to a stunning +78.8% in West Virginia.
    (Maine & DC are running just 0.1% & 1.3% behind last year respectively)
  • In addition to West Virginia, other states running more than 50% ahead of 2023 include Louisiana, Tennessee, Ohio, Indiana, Mississippi, Arkansas, Georgia, South Carolina & Arizona.
  • In terms of raw enrollment, a whopping 4 MILLION Floridians are now enrolled in ACA exchange plans. That's over 18% of the entire state population.
  • In terms of raw numeric growth, over 1 MILLION more Texans are now enrolled in ACA exchange plans than a year ago, for a total of 3.3 million.
  • The 10 Medicaid NON-expansion states have added 63% of the additional enrollees, with 42% average enrollment growth. CMS hasn't provided an income bracket breakout yet, but assuming that 42% was proportional across the income scale (it probably wasn't), that means that something like 5.2 million of the enrollees in these ten states would be enrolled in Medicaid instead if all ten expanded the program.
  • Speaking of state expanding Medicaid last year, North Carolina increased enrollment by an impressive 32% from lasts year, which is particularly impressive given that upwards of 280,000 of their existing exchange enrollees became eligible for Medicaid instead starting December 1st. If that hadn't happened, North Carolina's enrollment (as well as the national tally) would be up to 280K higher yet.
  • Similarly, South Dakota also saw a more modest enrollment increase of 16% even though they also expanded Medicaid in 2023, although they did so starting back in July so there isn't as obvious of an impact.

As for how many more people have signed up for coverage since 12/23 (and how many more will do so between now and the end of Open Enrollment between 1/15 - 1/31 depending on the state), I don't know for sure of course, but I can make an educated guess:

  • Last year around 740,000 additional people enrolled nationally between 12/25 - the end of Open Enrollment.
  • Just about all additional enrollees since 12/15 are new. So far new enrollment has run around 31% ahead of last year.
  • Assuming that pace continues from 12/24 - the end of January, that would mean an additional 970,000 enrollees on top of the 20.35 million confirmed by CMS to date.
  • That would bring the total up to over 21.3 million QHP selections...not including the 1.3 million BHP enrollees. Throw them on top and you're at a potential grand total of 22.6 million.

...which, as it happens, would be right in the zone of my 22 - 24M estimate from a week or so ago.

UPDATE: Here's another way of looking at it. There are 7 state-based exchanges where I have hard enrollment data since 12/23/23. On average these seven states suggest that overall enrollment has increased by around 3.7% since then, or around an additional 750K, and these states are only running about 20% higher year over year so far, well below the 33% national average. If they're remotely representative I could easily see the final total being 1.0M higher than today's press release or more.