Under the Biden-Harris Administration, Over 20 Million Selected Affordable Health Coverage in ACA Marketplace Since Start of Open Enrollment Period, a Record High
As January 16 coverage deadline approaches, Biden-Harris Administration continues to encourage Americans to sign up for quality, affordable health care coverage
Under the Biden-Harris Administration, the U.S. Department of Health and Human Services announced today that over 20 million people have selected an Affordable Care Act (ACA) Health Insurance Marketplace plan since the 2024 Marketplace Open Enrollment Period launched on November 1 — a record number of enrollments.
CMS's press release states that they won't be posting the next detailed/state-by-state enrollment breakout until January 10th, so aside from a handful of minor SBM updates here and there, there hasn't been much to report on the enrollment front since then...until this:
Just 3 days ago, I posted a revised 2024 ACA Open Enrollment Period projection, in which I upgraded my prior projection from 18.5 million Americans signing up for either Qualified Health Plans (QHPs) or Basic Health Plans (BHPs) combined nationally to over 19 million doing so. That 18.5M projection was itself a drop from my original projection of 19M QHPs + BHPs combined from a month earlier.
I delved into the various reasons for both my original and revised projections, but the bottom line is that I figured it would end up being somewhere in the neighborhood of 19 - 19.5 million, give or take, likely broken out something like ~18 million QHPs plus another ~1.3 million BHPs in New York & Minnesota only.
I even included 20 million as an outside possibility.
Back on November 5th, just a few days into the 2024 Open Enrollment Period, I did some back-of-the-math number crunching and concluded that the odds were pretty good that total 2024 OEP ACA enrollment (including both exchange-based Qualified Health Plans, or QHPs, as well as enrollment in Basic Health Plans (BHPs) in New York & Minnesota only) would break 19 million people for the first time in the ACA's history.
As long-time readers know, every year during the ACA Open Enrollment Period (OEP) I have a tradition of regularly updating a graph tracking how many Americans have enrolled in on-exchange Qualified Health Plan (QHP) policies nationally. The Graph®, as I've come to call it, is how this entire website got started; the logo for ACA Signups even consists of a stylized version of the original version from the 2013 - 2014 OEP.
That first year I attempted to track every conceivable population--on-exchange QHPs, off-exchange QHPs, Medicaid expansion enrollment, SHOP (ACA small business exchange) enrollees) and even the amorphous "sub-26er" populations of young adults enrolled in their parents employer plans thanks to ACA provisions. Some of these were nearly impossible to accurately estimate, but I really tried my best.
Over the next year or two, I not only dropped the categories which I wasn't able to track properly, my tracking of the remaining ones became much more streamlined and sophisticated. Eventually I decided to stick with just two categories: On-exchange QHPs and those enrolled in the Basic Health Plan (BHP) programs in Minnesota and New York.
In June 2023, 92,614,205 individuals were enrolled in Medicaid and CHIP.
85,614,581 individuals were enrolled in Medicaid in June 2023, a decrease of 1,169,095 individuals (1.3%) from May 2023.
6,999,624 individuals were enrolled in CHIP in June 2023, a decrease of 32,449 individuals (0.5%) from May 2023.
As of June 2023, enrollment in Medicaid and CHIP has decreased by 1,304,004 since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
Governor Kathy Hochul today encouraged eligible New Yorkers to renew their health insurance coverage as insurance renewal deadlines rapidly approach. The Governor also issued a public service announcement to get the message out to New Yorkers.
Back in late January, I crunched the numbers on the total number of Americans who currently have healthcare coverage directly via the Affordable Care Act. This includes three categories: Exchange-based Qualified Health Plans (QHPs); the Basic Health Plan (BHP) progams in Minnesota and New York; and Medicaid Expansion in the 38 states (+DC) which had implemented it as of that point.
I concluded that the total numbers for each were roughly 15.4 million QHPs, 1.2 million BHPs and 23.5 million Medicaid expansion enrollees, or around 40.1 million people total.
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) confirmed my estimates and even came in slightly higher, at around 40.2 million. They put effectuated QHPs at 15.6 million and Medicaid expansion enrollment at around 23.4 million.
The press release talks about "more than 35 million" being enrolled, but when you look at the actual data, it's almost certainly over 36 million as of today. Here's how they break it out:
Effectuated ACA exchange enrollment as of March 2022: 13,640,412
Medicaid Expansion (newly eligible) as of October 2021: 16,781,800
Medicaid Expansion (previously eligible) as of October 2021: 4,261,277
Basic Health Plan enrollment as of March 2022: 1,135,190
TOTAL: 35,818,679
Notice that even without delving further, the total is already over 35.8 million.
However, there's two important dates to look at here: First, the Medicaid Expansion totals are only up to date as of last October, a good 6 months ago.
There's still likely between 40,000 - 80,000 Qualified Health Plan (QHP) enrollments to be added to the 2023 Open Enrollment Period (OEP) tally from the states which have extended deadlines (through Tuesday, January 31st), but I decided to throw this together today for the hell of it.
The table below charts the first ten years of ACA Open Enrollment Periods, broken out by state. I've also included Basic Health Plan (BHP) enrollment in Minnesota & New York, the only states where BHP programs have been implemented to date.
The states which jump out at me the most in terms of enrollment growth, at least visually, are Florida, Georgia, New York (BHPs) and Texas.
No further analysis or comment here; I just think this is a pretty cool graphic.
