Back in 2010, when the Affordable Care Act became law, then-Vice President Joe Biden famously called it a big f**king deal.
Now Biden has been president for a year, and, based on new enrollment figures, the law seems to be an even bigger f**king deal than it was before.
Approximately 14.5 million people signed up for private coverage through HealthCare.gov or one of 18 state-run marketplaces during this year’s open enrollment period, the Biden administration announced Thursday.
That is the highest number ever.
“Health care should be a right, not a privilege, for all Americans,” Biden said in a prepared statement that the White House released. “And one year into my Administration, we are making that right a reality for a record number of people — bringing down costs and increasing access for families across the country.”
It will take analysts some time to pinpoint who signed up and why, but the surging interest in Affordable Care Act coverage is not especially surprising, and, already, experts have identified several likely causes.
Those factors include the economic dislocations of the coronavirus pandemic, which left more people looking for insurance on their own, and an extended open enrollment period, which gave people more time to buy coverage. (In five states, plus the District of Columbia, open enrollment actually won’t end until the end of the month.)
The Biden administration has also plowed extra money into promoting the Affordable Care Act and supporting “navigators,” the counselors and organizations that help individuals enroll. The Trump administration had slashed such spending during its four years.
But quite possibly the most important reason for the record enrollment is that the insurance itself has become a lot cheaper, thanks to the 2021 COVID-19 relief legislation that Democrats in Congress passed and Biden signed last March.
A key provision of that legislation expanded the subsidies available to people buying Affordable Care Act insurance. Now subsidies are available to people whose income was too high to qualify for assistance previously, while those who already got assistance are eligible for even more than they received before.
The differences in some cases are dramatic, with premiums dropping by thousands of dollars a year for some consumers. They can pocket the savings or use the money to pay for more expensive, more generous coverage.
The high sign-up count also suggests that the number of Americans without insurance will remain at or near historic lows, helping to fulfill the Affordable Care Act’s primary goal of expanding coverage.
But the effect is unlikely to last if Congress does not act, because the extra financial assistance expires after 2022.
Both Biden and Democratic leaders have said they want to extend the subsidies and ideally make them permanent as part of the Build Back Better legislation they have been crafting and debating for the past year. But progress stalled in December, when Sen. Joe Manchin (D-W.Va.) indicated he could not vote for the legislation ― in part because of how much new federal spending it would require.
The new subsidies are among the items in the legislation that would require substantial new spending ― somewhere on the order of hundreds of billions of dollars over the 10-year budget planning window, with the exact amount depending on the structure and duration of the extension.
But while Manchin has balked at Build Back Better’s overall price tag for the government, he has not raised public objections to the Affordable Care Act provisions. And in recent years, Manchin has generally been supportive of the Affordable Care Act.
In 2017, he ended up voting against Republican repeal efforts. In 2018, he touted that opposition in his successful reelection bid.
Whether Manchin and the rest of his party will come to an agreement on legislation remains an open question ― and a critical one. Because Democrats have only 50 votes in the sharply divided Senate and because no Republicans seem interested in supporting the bill, the legislation almost certainly cannot pass without Manchin’s OK.
Biden has said he is committed to finding an agreement, somehow. And on Thursday, he reiterated his determination to make an extension of Affordable Care Act subsidies part of the final package.
“As long as any American lies awake at night, wondering how they’re going to pay their medical bills, my Administration will keep fighting to lower costs and expand health coverage even more — including through my Build Back Better agenda,” Biden said.