In January, preliminary data showed the Affordable Care Act marketplaces had record-high enrollment for the fourth straight year, Jared Ortaliza reported for KFF.
At least 23.6 million people had signed up for ACA coverage by Jan. 4, surpassing the previous record high of 21.4 million enrollees who signed up during open enrollment in 2024, he wrote. What’s more, enrollment for 2025 is likely to rise still further after officials tally data from all states. Open enrollment ended in many states on Jan. 15, and the last state to end enrollment for coverage this year was Rhode Island, where enrollment ended on Feb. 28.
The record-breaking rise in ACA enrollment resulted largely because Congress provided more financial assistance to consumers buying health insurance coverage through the ACA marketplaces, Ortaliza reported. This financial assistance is known as enhanced subsidies or advance premium tax credits for health insurance. “As coverage became more affordable (or free, in some cases), marketplace signups increased,” he added.
In the American Rescue Plan Act of 2021, Congress included temporary funding to boost financial assistance for ACA enrollees in 2021 and 2022. In the Inflation Reduction Act of 2022, Congress extended that assistance for 2023, 2024 and 2025, Ortaliza added. That additional financial assistance is due to end on Dec. 31, 2025.
If Congress does not renew the subsidies, enrollment premiums could rise by more than 75%, forcing millions of ACA members to drop their coverage, Ortaliza wrote.
On Jan. 8, HHS reported that the financial assistance helped to drive down the percentage of Americans without health insurance from 16% in 2010, when the ACA became law, to 7.6% in the second quarter of 2024. That report also showed that the financial assistance helped some rural consumers save $890 on premiums a year and urban consumers saved $695 annually.
As expected, increased health insurance coverage improved consumers’ access to care, the HHS report added. “The share of children delaying care due to cost fell from 4.1% in 2010 to 2.5% in 2015 and then to 1.0% in 2023,” the report showed. “For adults, this measure of financial barriers fell significantly from 13.5% in 2010 to 9.2% in 2015 and then to 8.5% in 2023.”
If lawmakers do not extend the financial assistance, the cost of ACA health insurance premiums will rise sharply, causing 4 million to 5 million Americans to lose their health insurance coverage, the HHS report predicted.