Affordable Care Act Registration Is Now More Expansive

More than 16.3 million people selected a plan on the ACA marketplaces, based on data released Wednesday by the administration. Since President Biden took office, the number of people signed up for a program through HealthCare.gov has grown by nearly 50%.

More than 1.8 million more people have signed up for ACA health insurance, or a 13% increase, from last year, the administration said, and 3.6 million people who selected plans were new to the marketplace rather than returning to renew coverage.

The rise in enrollments has helped lower the number of uninsured people under age 65, which fell to a record low of 8% in early 2022 from 10.5% in 2021 and 11.1% in 2019, according to the Department of Health and Human Services.

Democrats say the robust enrollment is evidence the ACA is becoming an increasingly stable part of the U.S. health landscape after the Trump administration sought to undermine the law.

Republicans and critics of the law say Democrats’ efforts to grow the ACA through more generous consumer subsidies have made it an expensive program and a strain on the federal deficit. The federal government spent about $72 billion in 2022 for subsidies to lower premiums, according to projections by the Congressional Budget Office and the Joint Committee on Taxation. Spending had hovered around $58 billion in 2021.

The ACA has drawn more consumers partly because congressional lawmakers made more people eligible and enhanced the subsidies people can get that reduce premiums. The Inflation Reduction Act, which was signed in August 2022, will maintain the more generous donations through 2025.

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The subsidies have helped buffer many health-plan shoppers from escalating premiums in 2023, increases propelled mainly by inflation and more use of healthcare. Insurers on the ACA marketplaces proposed median monthly premium hikes of 10%, according to a review of more than 70 insurers in 13 states by the Kaiser Family Foundation.

The administration said that despite the rising premiums, the more generous subsidies mean four out of five people who returned to HealthCare.gov could find a plan for $10 or less a month.

Claire Sachs, 45 years old, of Bethesda, Md., saw her monthly premiums go up from $168 in 2022 to about $250 in 2023, although she also added dental coverage that cost about $50 a month. Ms. Sachs, a patient advocate and healthcare experience consultant said she could own her own business because she can purchase coverage that helps her manage several medical conditions, such as diabetes.

“I do think it’s absolutely worth it,” said Ms. Sachs. “When we don’t have an option, we are in a situation of job lock. I can’t be an entrepreneur without the exchanges.”

Enrollment also has been on the upswing because the Biden administration has poured millions of dollars into outreach and customer assistance. The Centers for Medicare and Medicaid Services boosted grant funding for navigators, who help people sign up for coverage, for the 2023 plan year by almost $100 million. In contrast, the Trump administration in 2017 gave $36.8 million in grants to navigators.

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The law’s supporters say the rise in enrollments indicates the ACA can act as an adequate safety net during tough economic times, providing health coverage to people who lost jobs during the pandemic.

“That’s huge for families,” said Frederick Isasi, executive director of Families USA, a health advocacy and policy organization. “If someone gets sick, they will not lose their life savings. As the pandemic hit, we saw the exchanges function as intended.”

Critics say the expanded subsidies are bad public policy. Most of the financial benefit went to people who already had health coverage, said Brian Blase, president of Paragon Health Institute, a health policy research center. He said federal spending has largely replaced spending that otherwise would have been private.

“Regarding rising enrollment, I don’t think it’s surprising. The vast majority of the cost is paid by taxpayers, so enrollees are getting something for almost nothing,” said Mr. Blase, a special assistant to the White House on health policy during the Trump administration. “Small employers are likely dropping coverage because of the expanded subsidies.”