More than 1 million Americans have signed up for coverage at HealthCare.gov since February, taking advantage of an extended open enrollment period and new financial assistance that President Joe Biden and his Democratic allies put in place as part of the federal government’s COVID-19 response.
HealthCare.gov, the federally run online marketplace for people buying insurance on their own, exists because of the Affordable Care Act. In a prepared statement announcing the 1 million figure on Tuesday morning, Biden hailed the news as more proof that the health care law, also known as Obamacare, has become a “lifeline” during the coronavirus pandemic.
“That’s 1 million more Americans who now have the peace of mind that comes from having health insurance,” Biden said. “One million more Americans who don’t have to lie awake at night worrying about what happens if they or one of their family members gets sick.”
“As we navigate the COVID-19 pandemic and its aftermath, it’s more critical than ever for Americans to have access to quality, affordable health care,” added Health and Human Services Secretary Xavier Becerra.
Biden And The Democrats Gave The ACA Some Upgrades
The Affordable Care Act is working better these days and reaching more people because it has both a president who wants it to succeed and a Congress eager to reinforce the program through legislation.
Usually, open enrollment at HealthCare.gov takes place for a few weeks at the end of the calendar year. One of Biden’s earliest executive actions was to launch a new open-enrollment period, which he then extended through Aug. 15.
That eagerness to enroll people represents quite a change from the previous administration. Former President Donald Trump spent the first year of his presidency trying to repeal the Affordable Care Act and, after that failed, he slashed the budget for promoting the program.
But Biden did more than simply give people extra time to enroll. He also worked with Democrats in Congress to craft and then enact the American Rescue Plan. That law, which Biden signed in March, substantially increased the financial assistance to people buying coverage at HealthCare.gov.
The law also made the assistance more widely available by eliminating a rule limiting it to people with incomes of less than four times the poverty line. That works out to about $106,000 a year for a family of four.
Former President Barack Obama and the Democrats had hoped to make these sorts of changes to the law in the years following its 2010 enactment. But they couldn’t pass legislation because Republicans, who were dead-set against anything that might bolster the law, always controlled at least one house of Congress.
“We don’t know for sure, but I suspect this is mostly people who didn’t have coverage at all before.”
It will take time and analysis to figure out exactly how these changes have affected different groups of people and what the ultimate effect on the number of uninsured Americans has been.
But there is good reason to think that most of the people getting coverage this year are people who wouldn’t have had insurance otherwise, according to Larry Levitt, executive vice president of the Henry J. Kaiser Family Foundation, a research organization that focuses on health care.
“We don’t know for sure, but I suspect this is mostly people who didn’t have coverage at all before,” Levitt told HuffPost, based on data published prior to Tuesday’s announcement. “Maybe they had employer coverage at one point, but likely not recently. We just had an open enrollment period, and the number of layoffs has slowed significantly. Also, throughout this pandemic-fueled economic crisis, the people losing work have mostly been in lower-wage jobs that often didn’t come with health benefits to begin with.”
Levitt noted that sign-ups will probably continue to increase for a while, given that the special open enrollment still has three months to go and many would-be buyers are only now becoming aware of the new assistance.
And it’s not just the newly insured who stand to benefit. People who were already buying subsidized coverage could save an average of $50 a month, according to administration estimates.
HealthCare.gov does not serve every state. Fourteen states plus the District of Columbia run their own marketplaces. But they have also reopened enrollment (although not always through August), and their policies use the same subsidies.
Enrollment in those states, which include California and New York, has likely pushed total enrollment this year to 1.5 million, and possibly higher, according to analyst Charles Gaba of the website ACASignups.net.
Democrats Want To Make ACA Improvements Permanent
That extra financial assistance will not last forever. It’s only a two-year boost whose primary justification was the dire crisis that the pandemic created.
But Biden and the Democrats have said they want to make the increases permanent, as part of one of the long-term economic packages they hope to enact this year. Biden in his statement issued a new call for such an extension.
“Today’s milestone demonstrates that there is a need and a demand for high-quality, affordable health insurance across this country,” Biden said. “It is up to Congress to hear them, and act quickly.”
Like all policy changes, making the ACA improvements permanent would require some tradeoffs. For one thing, the federal government would have to find the money. The Biden administration has said its proposal would require $200 billion in new spending over 10 years.
Even with additional financial assistance, the U.S. would still not have universal coverage, which was the aspiration of the Affordable Care Act’s architects ― and, for that matter, of Democrats going back to the days of Harry Truman. Getting to the point where every American has comprehensive coverage would require more sweeping action.