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.
Across 38 states, a total of around 19.5 million people have selected Qualified Health Plans (QHPs) via either the federal or state-based exchanges as of anywhere from 12/05 - 12/18. Collectively, this is roughly 16.6% higher than the same/nearly the same dates a year ago.
It's important to remember that Georgia moved from the federal exchange to its own state-based marketplace this year, which is why ~1.2 million enrollees have been subtracted from the 2024 HC.gov total. Note that the HC.gov numbers are rounded off to the nearest 100K, per CMS's press releases both years.
Now that the two largest ACA marketplaces (HealthCare.Gov, which hosts 31 states, and Covered California) have joined a half-dozen other states in posting fairly recent 2025 Open Enrollment Period updates, I figured it would be a good time to take a look at where things stand ahead of the big holiday break.
Across 38 states, a total of around 19.5 million people have selected Qualified Health Plans (QHPs) via either the federal or state-based exchanges as of anywhere from 12/05 - 12/18. Collectively, this is roughly 16.6% higher than the same/nearly the same dates a year ago. It's important to remember that Georgia moved from the federal exchange to its own state-based marketplace this year, which is why ~1.2 million enrollees have been subtracted from the 2024 HC.gov total. Note that the HC.gov numbers are rounded off to the nearest 100K, per CMS's press releases both years.
Re: The Effects of Not Extending the Expanded Premium Tax Credits for the Number of Uninsured People and the Growth in Premiums
Dear Chairman Wyden, Ranking Member Neal, Senator Shaheen, and Congresswoman Underwood:
You have asked the Congressional Budget Office to discuss the effects on health insurance coverage and premiums that will result from not extending—either for one year or permanently—the expanded premium tax credit structure provided in the American Rescue Plan Act of 2021 (ARPA, Public Law 117-2).
ARPA reduced the maximum amount eligible enrollees must contribute toward premiums for health insurance purchased through the marketplaces established by the Affordable Care Act, and it extended eligibility to people whose income is above 400 percent of the federal poverty level (FPL). Those provisions were extended through calendar year 2025 in the 2022 reconciliation act (P.L. 117-169).
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.
(sigh) Annnnd here we go again. 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 (spoiler: the grand total is a little shy of 45 million people nationally), I'm taking it several steps further this time and breaking it out not only by state, but by Congressional District (CD).
Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.
However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.
As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.
Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.
However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.
As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.
Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.
However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.
As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.
Covered California announced today that more than 158,000 Californians remained covered through the Medi-Cal to Covered California enrollment program over the past year.
Beginning in April 2023, following the end of the federal continuous coverage requirement put in place during the COVID-19 pandemic, Medi-Cal resumed its renewal process by redetermining eligibility for over 15 million of its members. In May 2023, Covered California and the Department of Health Care Services (DHCS), which administers California’s Medi-Cal program, launched the Medi-Cal to Covered California enrollment program.
Under the program, Covered California automatically enrolls individuals in one of its low-cost health plans when they lose Medi-Cal coverage and gain eligibility for financial help through Covered California. Through early June of 2024, the program has helped 158,100 Californians remain insured.
Normally, states will review (or "redetermine") whether people enrolled in Medicaid or the CHIP program are still eligible to be covered by it on a monthly (or in some cases, quarterly, I believe) basis.
However, the federal Families First Coronavirus Response Act (FFCRA), passed by Congress at the start of the COVID-19 pandemic in March 2020, included a provision requiring state Medicaid programs to keep people enrolled through the end of the Public Health Emergency (PHE). In return, states received higher federal funding to the tune of billions of dollars.
As a result, there are tens of millions of Medicaid/CHIP enrollees who didn't have their eligibility status redetermined for as long as three years.
