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:
In October 2024, 79.3 million individuals were enrolled in Medicaid and CHIP.
72.1 million individuals were enrolled in Medicaid, and 7.2 million individuals were enrolled in CHIP.
41.7 million adults were enrolled in Medicaid, and there were 37.6 million Medicaid child and CHIP enrollees.
Medicaid and CHIP Applications Received
In October 2024, Medicaid, CHIP, Human Services agencies, and State-based Marketplaces received 2.6 million applications, or 2 percent more applications, as compared to September 2024.
The number of applications received has increased by 20 percent since October 2023 and increased by 66 percent since October 2022.
Total Medicaid/CHIP enrollment in October 2024 still dropped very slightly from September...by just 55,000 people.
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:
Number of People Who Have Ever Enrolled in ACA Marketplace Coverage, 2014-2024
The Affordable Care Act (ACA) created Health Insurance Marketplaces in all states starting in 2014. Eligible partcipants can purchase individual health insurance plans in the ACA Marketplaces, and qualifying individuals can receive Premium Tax Credits (PTC) to help offset the cost of coverage. The PTC was expanded in both generosity and eligibility startng with the American Rescue Plan Act in 2021, with these enhancements extended in the Inflaton Reducton Act in 2022. The ACA Marketplaces enable Americans to purchase comprehensive, affordable health insurance that they may not have access to through their employers or through programs such as Medicare or Medicaid, including when they experience brief or longer-term gaps in the availability of other coverage.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year.
