In Celebration of 10 Years of ACA Marketplaces, the Biden-Harris Administration Releases Historic Enrollment Data

Under President Biden, over 45 million people have coverage thanks to the Affordable Care Act and key actions taken under the Administration to strengthen the law

Today, the U.S. Department of Health and Human Services (HHS) issued four new reports showing that President Biden’s efforts to strengthen the Affordable Care Act (ACA) are linked to historic gains in Americans’ health insurance coverage. Today’s announcements include a report from the Centers for Medicare & Medicaid Services (CMS) showing that over 21 million consumers selected or were automatically re-enrolled in health insurance coverage through HealthCare.gov and State-based Marketplaces during 2024’s Open Enrollment Period (OEP). Three reports from HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) highlight current enrollment trends, enrollment trends broken down by race and ethnicity, and how the ACA Marketplaces have evolved and strengthened during the first ten years. ASPE analysis shows that today over 45 million people have coverage thanks to the Affordable Care Act’s Marketplaces and Medicaid expansion.

“On the ten-year anniversary of the ACA Marketplaces, HHS is releasing data that shows just how profoundly it has reshaped what health care looks like for so many Americans. The Marketplaces have become a pillar of American society, a guaranteed place where people can find affordable, quality coverage,” said HHS Secretary Xavier Becerra. “Thanks to President Biden’s leadership, more than 21 million Americans have health insurance through the Affordable Care Act Marketplaces, an all-time high, with millions of families saving hundreds of dollars every month. At HHS, we will keep doing everything we can to ensure more people have access to affordable, high-quality health care and the peace of mind that comes with it.”

“As we look back and celebrate the historic achievements of the Affordable Care Act, the law continues to live up to its purpose of providing affordable, quality health care coverage to Americans. Gone are the days when being a woman was considered a pre-existing condition or sick children could be denied health insurance. Today, over 100 million Americans have coverage through either Marketplace or Medicaid, thanks (in part) to increased affordability thanks to the Inflation Reduction Act,” said Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure. “And we’re not stopping. Our commitment to strengthening the ACA and increasing access to affordable, comprehensive health care coverage has never been stronger.”

The Biden-Harris Administration has taken unprecedented action to make health insurance available and affordable to everyone. National estimates show that most consumers qualified for $0 premiums or are saving at least $800 a year on their premium, underscoring the importance of the American Rescue Plan and Inflation Reduction Act. Overall, four in five HealthCare.gov customers were able to select from health care coverage options that were $10 or less per month.  Additionally, the Biden-Harris Administration issued almost $100 million for organizations to hire staff to help consumers find affordable, comprehensive health coverage. Navigators, as they are known, have been key to helping consumers in every state. 

Key points from today’s reports include the following.

2024: Total Marketplace Plan Selections During 2024 Open Enrollment Period

• During the 2024 Open Enrollment Period (OEP), over 21.4 million consumers selected or were automatically re-enrolled in health insurance coverage through HealthCare.gov Marketplaces and State-Based Marketplaces (SBMs).
• 5.1 million more consumers signed up for coverage during the 2024 OEP compared to the 2023 OEP, a 31% increase.
• In HealthCare.gov Marketplaces, 16.4 million consumers selected plans during the 2024 OEP between November 1, 2023 and January 16, 2024.
• Across the 19 SBMs, 5.1 million consumers selected plans during the 2024 OEP from November 1, 2023 through the end of their respective OEPs.
• 5.2 million people who signed up for coverage did so for the first time, a 41% increase from 3.7 million during the previous OEP.
• Nationwide, 44% of consumers selected a plan for $10 or less per month after APTC during the 2024 OEP.

2024: Coverage Under the Affordable Care Act:  Current Enrollment Trends and State Estimates

• 18.6 million people have coverage thanks to the ACA’s Medicaid expansion.
• Across coverage groups, a total of 45 million Americans are enrolled in coverage related to the ACA, the highest total on record.  This represents 14.1 million more people enrolled than in 2021 (a 46% increase) and 32.5 million more people enrolled than in 2014 (a 258% increase, or more than triple). 
• Survey results indicate that all 50 states and the District of Columbia have experienced substantial reductions in their uninsured rates since 2013, the last year before implementation of the ACA.

2015-2023: ASPE Marketplace Enrollment by Race and Ethnicity Issue Brief

• Biden-Harris Administration policies – such as expanded and enhanced premium tax credits under the American Rescue Plan and the Inflation Reduction Act and increased Marketplace outreach and Navigator funding – likely contributed to gains in health coverage, particularly among low-income populations and communities of color.
• Black Americans and Latinos continued to enroll in health coverage through the Marketplace at high rates. An estimated 1.7 million Black people and 3.4 million Latino people enrolled in Marketplace plans in HealthCare.gov states during the 2023 Open Enrollment Period, representing enrollment increases of 95% and 103% respectively since 2020.
• The number of Asian-American, Native Hawaiian, and Pacific Islander (AANHPI) enrollees increased by 14 percent between 2020 and 2023.
• Over half of Black, Latino, and Asian American enrollees select silver plans with cost sharing reductions, making it the most frequently selected plan. These plans with cost sharing reductions allow patients below a certain income to pay less out of pocket each time they receive medical services. 

2014-2024: How the ACA Marketplaces have evolved in 10 years

• The ACA substantially transformed health insurance by creating Health Insurance Marketplaces where consumers can shop for private comprehensive coverage that meets consumer protection and coverage standards
• The number of issuers participating in Marketplaces has grown in recent years providing nearly all Marketplace consumers (96 percent) with a choice of plan offerings of at least three different issuers.  This increase in market competition has contributed to premiums that are more affordable for both enrollees and taxpayers.  In 2024, 210 health insurance issuers are participating in Marketplaces.
• Between 2013 and the third quarter of 2023, the uninsured rate for all ages fell from 14.4 percent to 7.7 percent.  Since 2013, the uninsured rate for children has decreased from 6.5 percent to 3.4 percent in 2023.
• The ACA brought key consumer protections, such as preventing consumers from getting denied or charged more for coverage due to pre-existing conditions, age, and gender.
  • For example, prior to the ACA, 92 percent of popular plans used gender rating.  A woman could pay as much as 81 percent more for the same plan as a man of the same age, even without the plan covering maternity care
• Prior to the ACA, health plans also often limited the benefits they covered. In 2011, 62 percent of individual market enrollees did not have coverage for maternity services, 34 percent did not have coverage for substance use disorder services, 18 percent did not have coverage for mental health services, and nine percent of enrollees did not have coverage for prescription drugs.