Back on November 5th, just a few days into the 2024 Open Enrollment Period, I did some back-of-the-math number crunching and concluded that the odds were pretty good that total 2024 OEP ACA enrollment (including both exchange-based Qualified Health Plans, or QHPs, as well as enrollment in Basic Health Plans (BHPs) in New York & Minnesota only) would break 19 million people for the first time in the ACA's history.
As long-time readers know, every year during the ACA Open Enrollment Period (OEP) I have a tradition of regularly updating a graph tracking how many Americans have enrolled in on-exchange Qualified Health Plan (QHP) policies nationally. The Graph®, as I've come to call it, is how this entire website got started; the logo for ACA Signups even consists of a stylized version of the original version from the 2013 - 2014 OEP.
That first year I attempted to track every conceivable population--on-exchange QHPs, off-exchange QHPs, Medicaid expansion enrollment, SHOP (ACA small business exchange) enrollees) and even the amorphous "sub-26er" populations of young adults enrolled in their parents employer plans thanks to ACA provisions. Some of these were nearly impossible to accurately estimate, but I really tried my best.
Over the next year or two, I not only dropped the categories which I wasn't able to track properly, my tracking of the remaining ones became much more streamlined and sophisticated. Eventually I decided to stick with just two categories: On-exchange QHPs and those enrolled in the Basic Health Plan (BHP) programs in Minnesota and New York.
In June 2023, 92,614,205 individuals were enrolled in Medicaid and CHIP.
85,614,581 individuals were enrolled in Medicaid in June 2023, a decrease of 1,169,095 individuals (1.3%) from May 2023.
6,999,624 individuals were enrolled in CHIP in June 2023, a decrease of 32,449 individuals (0.5%) from May 2023.
As of June 2023, enrollment in Medicaid and CHIP has decreased by 1,304,004 since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
Governor Kathy Hochul today encouraged eligible New Yorkers to renew their health insurance coverage as insurance renewal deadlines rapidly approach. The Governor also issued a public service announcement to get the message out to New Yorkers.
Back in late January, I crunched the numbers on the total number of Americans who currently have healthcare coverage directly via the Affordable Care Act. This includes three categories: Exchange-based Qualified Health Plans (QHPs); the Basic Health Plan (BHP) progams in Minnesota and New York; and Medicaid Expansion in the 38 states (+DC) which had implemented it as of that point.
I concluded that the total numbers for each were roughly 15.4 million QHPs, 1.2 million BHPs and 23.5 million Medicaid expansion enrollees, or around 40.1 million people total.
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) confirmed my estimates and even came in slightly higher, at around 40.2 million. They put effectuated QHPs at 15.6 million and Medicaid expansion enrollment at around 23.4 million.
The press release talks about "more than 35 million" being enrolled, but when you look at the actual data, it's almost certainly over 36 million as of today. Here's how they break it out:
Effectuated ACA exchange enrollment as of March 2022: 13,640,412
Medicaid Expansion (newly eligible) as of October 2021: 16,781,800
Medicaid Expansion (previously eligible) as of October 2021: 4,261,277
Basic Health Plan enrollment as of March 2022: 1,135,190
TOTAL: 35,818,679
Notice that even without delving further, the total is already over 35.8 million.
However, there's two important dates to look at here: First, the Medicaid Expansion totals are only up to date as of last October, a good 6 months ago.
There's still likely between 40,000 - 80,000 Qualified Health Plan (QHP) enrollments to be added to the 2023 Open Enrollment Period (OEP) tally from the states which have extended deadlines (through Tuesday, January 31st), but I decided to throw this together today for the hell of it.
The table below charts the first ten years of ACA Open Enrollment Periods, broken out by state. I've also included Basic Health Plan (BHP) enrollment in Minnesota & New York, the only states where BHP programs have been implemented to date.
The states which jump out at me the most in terms of enrollment growth, at least visually, are Florida, Georgia, New York (BHPs) and Texas.
No further analysis or comment here; I just think this is a pretty cool graphic.
Biden-Harris Administration Announces Record-Breaking 16.3 Million People Signed Up for Health Care Coverage in ACA Marketplaces During 2022-2023 Open Enrollment Season
Nearly 50% increase in HealthCare.gov signups since President Biden took office, and 3.6 million people signed up for health care coverage on the Marketplaces for the first time this year
Today, the Biden-Harris Administration announced that a record-breaking more than 16.3 million people have selected an Affordable Care Act (ACA) Marketplace health plan nationwide during the 2023 Marketplace Open Enrollment Period (OEP) that ran from November 1, 2022- January 15, 2023 for most Marketplaces. President Biden promised to strengthen and build on the Affordable Care Act, and this year, the 10th year of ACA Open Enrollment, more Americans signed up for high-quality, affordable health insurance through the ACA Marketplaces than ever before. Since President Biden took office, the number of people who have signed up for an affordable health care plan through HealthCare.gov has increased by nearly 50%. Because of the President’s plan, millions of working families saved an average of $800 on their health insurance premiums last year.
As I noted in yesterday's analysis of the semi-final 2023 Open Enrollment Period report released by the Centers for Medicare & Medicaid Services, one of the most striking data points we're seeing this year is a significant drop in year over year on-exchange enrollment across a number of states operating their own ACA exchanges...even as enrollment continues to surge across states hosted on the federal exchange (HealthCare.Gov).
Overall, QHP enrollment in HC.gov states (Federally Facilitated Marketplaces, or FFMs) is up 19.6% vs. the same point last year, while QHP enrollment in state-based marketplace states (SBMs) is down 2.8% year over year:
As I noted this morning, Florida has by far the highest percent of its total statewide population enrolled in on-exchange ACA policies, with over 3.15 million Floridians enrolled so far (likely around 3.24 million when the final weekly numbers are included). This is 14.2% of Florida's total 2022 population according to the U.S. Census Bureau, or 1 in 7 residents of the state.
What about the other states? The table below sorts total 2023 OEP enrollment as of either 1/07/23 for federal exchange states (HC.gov) or 12/31/22 for state-based marketplace states (SBM) by what percent of the total state population has signed up so far. For New York and Minnesota the percent of total population includes each states Basic Health Plan (BHP) enrollment as well, since everyone enrolled in those plans would normally be eligible for a QHP instead:
