The private plans at HealthCare.gov and state-run marketplaces like Covered California are designed for people who can’t get affordable coverage through an employer and whose incomes are too high to qualify for Medicaid ― a group that, prior to full implementation of Obamacare in 2014, struggled mightily to find decent insurance within financial reach.
The plans now available have comprehensive benefits, with no exclusions or denials for preexisting conditions. And although they can have high premiums, copayments and deductibles, most people who buy coverage on the marketplaces also qualify for subsidies that bring down those costs, sometimes to the tune of many thousands of dollars a year.
Those savings are bigger now than they were when Biden took office, thanks to a temporary increase in subsidies Biden and Democrats enacted as part of their COVID-19 response and then renewed for three years as part of the Inflation Reduction Act.
“I promised to lower costs for families and ensure that all Americans have access to quality, affordable health care,” Biden said in a prepared statement. “Today, we received further proof that our efforts are delivering record-breaking results.”
The subsidy increases were part of a broader strategy by Biden and Democrats to bolster the Affordable Care Act, the signature domestic policy accomplishment of the Obama era that Republicans spent years trying to repeal, culminating in a failed effort in 2017 while Donald Trump was president and the GOP controlled Congress.
Trump also slashed funding for promoting the program and assisting Americans with enrollment. Overall marketplace enrollment during the Trump presidency fell slightly from where it was at the end of Barack Obama’s, although it’s not clear what role Trump’s management of the program played in that stagnation.
The 16.3 million number is not the final figure. It is likely to increase a bit as some final numbers come in from states that have longer enrollment periods and does not include a separate category of insurance ― “basic health plans” — that some states also make available.
Taking into account those numbers, total signups are already above 17 million, according to Charles Gaba, who runs the website ACASignups.net.
The surge in marketplace enrollment has taken place in tandem with a decline in the number of uninsured Americans, which is now at the lowest level the federal government has ever recorded. But the biggest driver of that change is likely a swelling of Medicaid rolls during the pandemic, when states agreed not to cancel coverage for people on the program in exchange for getting extra matching funds from the federal government.
That arrangement is about to end and, in April, states can once again start removing people from Medicaid if they determine they are no longer eligible. Projections suggest millions could lose coverage in this process, including many who actually remain eligible but will not realize they are losing coverage ― or fail to navigate the bureaucratic hurdles to stay on the program.
The Biden administration has said it wants to minimize that and has encouraged states to proceed with the “redetermination” process slowly. It’s not yet clear how many states will heed that advice.