Federal and state subsidies are driving record enrollment
OLYMPIA, Wash. – More Washingtonians than ever before have signed up for health and dental insurance for 2025 through Washington Healthplanfinder. Washington Health Benefit Exchange runs Washington Healthplanfinder, the state’s online marketplace for Affordable Care Act (ACA) coverage.
As of the close of open enrollment on Jan. 15, more than 308,000 Washingtonians had selected health and dental plans for 2025. This preliminary number includes people renewing their coverage and nearly 50,000 new customers.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
IMPORTANT: See caveats below regarding the impact of Medicaid Unwinding & other enrollment changes over time on these estimates.
12/12/24: Note: ACA Medicaid Expansion data has been updated by 3 months for most states, from March 2024 to June 2024.
With another GOP trifecta and Trump's Project 2025 promising draconian cuts to federal spending, there's a very good chance that the Affordable Care Act is, once again, on the chopping block.
I have no idea what's going to happen to either it, Medicaid, Medicare, the Children's Health Insurance Program (CHIP), the VA or the Indian Health Service, but whatever it is probably isn't gonna be pretty.
With that in mind, I figured it would be helpful to take stock of just how many Americans are actually receiving healthcare coverage through the ACA...and while I've crunched this number several times before, I'm taking it several steps further this time and breaking it out not only by state, but by Congressional District (CD).
I recently published an ambitious spreadsheet which attempted to compile a comprehensive & up to date tally of total ACA healthcare coverage (including both exchange-based Qualified Health Plans (QHPs), Basic Health Plans (BHPs) and ACA Medicaid expansion enrollment), broken out by not just state but by Congressional District.
Doing this on a state-by-state level is easy. Doing so by Congressional District (CD) gets a lot trickier.
As I noted in my prior article, for state level ACA enrollment I'm using official data reports from the Centers for Medicare & Medicaid Services (CMS) for the "baseline" numbers, supplemented by more recent state-level data from some of the state-based ACA exchanges & state Health & Human Services departments.
There's only a single CD in Alaska, Delaware, Montana, North Dakota, South Dakota, Vermont and Wyoming, as well as one non-voting House member in the District of Columbia, so no further work is needed for those. For the other 43 states, however, breaking the enrollment data out by CD gets trickier.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
SACRAMENTO, Calif. — Covered California has announced a special-enrollment period for residents of Los Angeles and Ventura counties, where a state of emergency has been declared due to the Palisades and Eaton Fires that have destroyed over 12,000 homes and displaced hundreds of thousands of Californians.
“These fires have caused unprecedented destruction and have upended the lives of so many living in Southern California,” said Covered California Executive Director Jessica Altman. “Everyone who is uninsured and has been affected by these fires, directly or indirectly, will have an extended opportunity to obtain health insurance through Covered California or Medi-Cal over the next two months.”
Californians have 60 days from the date that the state of emergency was declared in their county to sign up for coverage, so this special-enrollment period will last until March 8.
Other resources made available to Californians affected by the fires can be found here:
A week or so ago the Centers for Medicare & Medicaid Services (CMS) issued a semi-final 2025 ACA Open Enrollment Period report, which noted that 23.6 million Americans had selected 2025 plan year coverage via the various ACA marketplaces since November 1st...as of either January 4th or December 28th, depending on the state.
Those thru dates are important, of course, because the 2025 OEP was still ongoing in every state except Idaho at the time...and in fact it's still going on in several of them, including CA, DC, MA, NJ, NY, RI & VA. In some of these states the final deadline is still up to 2 weeks away.
The biggest program on the hit list, however, is Medicaid, which would make up nearly half of the $5 TRILLION in budget cuts Republicans have in mind in order to pay for...massive tax cuts for corporations & the wealthy, of course.
It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
