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Record Number of Americans Covered by Affordable Care Act Marketplaces and Expansion Medicaid

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Based on data from a new issue brief by the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE), the Biden administration announced a record 31 million Americans now have health care coverage because of Medicaid and the Affordable Care Act (ACA). ASPE advises the HHS Secretary on health care policy development, research, and analysis, and this issue brief explores enrollment trends nationally and by states. 

The enrollment numbers include people in ACA marketplace plans, those in expansion Medicaid in participating states, and those who enrolled in non-expansion Medicaid because of greater education and awareness of eligibility through ACA initiatives.

Since it became law, the ACA has driven down uninsured rates, with 20 million fewer uninsured people nationally. The largest improvements have come in the 37 states and the District of Columbia that have chosen to expand Medicaid. Other coverage gains have come from people having greater access to comprehensive plans through the federal and state-based insurance marketplaces.

Under current policies, these numbers are likely to continue to rise. One of the first big health coverage moves of the Biden administration was to create a special enrollment period (SEP) running from February 15 through August 15 that allows people to enroll in ACA plans if their state is one of the 36 that uses HealthCare.gov. Many states outside of the federal marketplace have followed suit, creating SEPs in their state-based exchanges. These SEPs have allowed new enrollees to join ACA plans, and 2021’s American Rescue Plan has made that coverage more affordable. That bill increased subsidies that drive down costs for both new and returning ACA plan enrollees—changes the administration would like to extend.

At Medicare Rights, we are encouraged by these enrollment numbers. We strongly support policies that increase the number of people who have affordable, high quality health care coverage. However, significant gaps remain, as many Medicare-eligible individuals are unable to quickly connect with coverage. Ensuring all Americans have access to care is vital, especially during a pandemic. We continue to urge Congress and the administration not to leave people with Medicare behind. 

Read the issue brief.

Read the announcement.

Read more about the American Rescue Plan’s impact on older adults and people with disabilities.

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