More than 20 million people have signed up for Obamacare plans, a record number

More than 20 million people signed up for plans on the Affordable Care Act marketplaces during the annual open enrollment period, far surpassing last year’s record of more than 16 million enrollments, the Biden administration announced Wednesday.

The figures were a milestone for the 2010 health care law and underscored the importance of increased subsidies for Americans and the continued reach of the marketplaces after years of Republican efforts to weaken them.

“The marketplaces are becoming stronger and more embedded in the fabric of American health care,” said Adrianna McIntyre, a health policy expert at the Harvard TH Chan School of Public Health. “The more the marketplaces grow, the more it increases their stability.”

The Biden administration revealed last month that as of Dec. 15 — the deadline to sign up for coverage that began Jan. 1 — nearly 750,000 people had signed up for a marketplace plan on HealthCare.gov, the most in a single day. The full number could grow in the coming days; the deadline to sign up for plans is January 17 at 5 a.m. Eastern, meaning U.S. coverage will begin next month.

“The Affordable Care Act is more popular than ever,” says President Biden said in a statement.

Those enrolled include people like Kennita Hickman, 39, who has several autoimmune diseases and was on the verge of losing her Medicaid coverage late last year because her income was too high to qualify for the government program. She found a lifeline in a free Obamacare plan, which gave her access to doctors and a therapist.

“I have three health issues to deal with,” said Ms. Hickman, who owns a media company in Milwaukee. “Being without insurance is always scary.”

Health policy experts say the record enrollment is largely due to higher federal subsidies for the marketplace purchasing plans, which were initially part of a 2021 congressional spending package. The subsidies, which increased at every income level, were extended until 2025.

Researchers have estimated that in the 30 or so states that use HealthCare.gov, premium payments without the subsidies would have been more than 50 percent higher on average.

The subsidies have proven helpful to a large segment of Americans, including those in upper-middle income groups. And they have allowed many lower-income Americans, including Ms. Hickman, to sign up for plans with no premiums and lower deductibles.

Some of those who signed up on the marketplaces lost Medicaid for the first time since the coronavirus pandemic began, after a federal rule guaranteeing coverage expired in April and forced millions of people to look for new plans.

In his statement on Wednesday, Mr. Biden called out “extreme Republicans” for efforts to block reforms.

“Their plan would raise costs for millions of people, especially older Americans and small business owners who rely on the marketplace for coverage, by repealing the improvements I signed into law,” he said. “In fact, they want to repeal the Affordable Care Act, just as my predecessor tried and failed to do.”

The political context was clear. Former President Donald J. Trump, the front-runner for the Republican presidential nomination, has threatened an overhaul of the Affordable Care Act in recent weeks, recalling the early months of his presidency when he cheered a failed Republican-led effort to dismantle healthcare. the law. Mr. Biden’s campaign quickly amplified Mr. Trump’s comments.

Trump may not get the party’s support to replace the health care law even if he wins the White House with full Republican control of Congress. After his threat some Republican lawmakers have suggested changing the markets to improve the quality and affordability of the plans, while others have admitted that there is likely to be little appetite for a wider withdrawal.

About six in 10 adults approve of the health care law, part of a steady increase in popularity since the same time in 2016, when only about four in 10 approved of it, according to poll published in May by KFF, a nonprofit health policy research group.

The plans were once again out of reach for middle-class Americans. People qualified for subsidies on a sliding scale based on income, with the remaining premiums sometimes unaffordable.

Critics of the health care law have argued that plans can be expensive even with increased federal subsidies. Coverage with lower premiums often comes with high deductibles and co-payments.

The record number reported Wednesday may be partly explained by the increasing size and sophistication of networks that help Americans choose new or different plans. The Biden administration has spent hundreds of millions of dollars strengthening these so-called navigator groups and the marketing campaigns that announce the marketplaces.

The federal government raised nearly $100 million in navigator organizations that contributed to increasing registrations this winter. One of those groups is Covering Wisconsin, which helped Ms. Hickman in her search for a plan last month.

“We’ve had more appointments than ever before,” said Adam VanSpankeren, the group’s program manager navigator. “Our agendas are full. In early November I had navigators with schedules booked Thanksgiving and beyond.

For Wisconsin, which has more than 40 navigators across the state, marketplace enrollment is up 82 percent compared to last year, Mr. VanSpankeren added.

Rawha Abouarabi, who oversees a federally funded navigator team in Michigan at the Arab Community Center for Economic and Social Services, said many of the people who signed up were like Ms. Hickman, with incomes just above the limit for Medicaid, but without the ability to sign up. for employer-sponsored insurance.

Ms Abouarabi said her group had enrolled more than 600 new people in plans since November, while about the same number had re-enrolled in the marketplace. A large majority of those who had already signed up for marketplace plans through her organization had returned this winter to re-enroll. That was a sign of the attractiveness of plans, she said.

In recent years, more and more insurance companies have entered the market, noticing the demand for coverage and the variety that Americans have looked for when choosing insurance policies.

“That can create a problem of overload of choices,” says Dr. McIntyre, a health policy expert at Harvard. But as more people sign up with these insurers, she adds, “the market becomes bigger and harder to disrupt.”