The extension of open enrollment in coverage in the Affordable Care Act (ACA) marketplaces is proving absolutely necessary. More than 528,000 Americans signed up for coverage in the first six week of the special enrollment period President Joe Biden opened in February.
That's a reflection of both the need because of the pandemic, and the fact that the Biden administration is actually making an effort to inform the public that this option is available to them. Signups in 2019 and 2020 outside of the normal open enrollment periods—for people who lost their jobs or had other major life changes like divorce or death of a spouse—saw combined just 380,000 enrollments over two years.
The outreach—and the greater affordability thanks to Biden's expansion of subsidies in the American Rescue Plan—has allowed more low-income people to sign up. It has also increased enrollment among Black Americans, the Department of Health and Human Services (HHS) said when announcing the numbers. Among those who identified by race, 17% of new enrollees are Black compared to about 11% in previous years. Among the new signups who are eligible for subsidies, 41% have income at or just above the federal poverty level, compared to 33% in 2019 and 38% in 2020.
The two states that have some of the highest rates of uninsured—and that have steadfastly refused to expand Medicaid—are leading the way in enrollments. Florida has had 146,000 people enroll, and Texas has had 98,000. These numbers, by the way, only reflect the enrollments in the 36 states that use the federal system, healthcare.gov, for their marketplaces. Numbers aren't available yet for all of the other states. These individual states also don't all have the same extension of the special enrollment period into August. For example, as of now Idaho has only extended it through the remainder of April.
Biden's major expansion of Obamacare in the COVID-19 relief bill, known as the American Rescue Plan, is the primary reason because with it came the fact that as many as 7 million of the nation's 29 million uninsured can get health insurance for $0. Free.
The expansion of subsides, HHS says, means that about 15 million uninsured—as well as current enrollees—can find plans for $10 or less with the subsidies. That's four out of five customers currently enrolled in ACA policies.
Which means it's not just the uninsured who should be taking advantage of the higher subsidies now available in ACA plans. People who are already buying their own insurance outside of the federal or state marketplaces can save money, but so can people who already have ACA plans. The special enrollment period also allows them to change plans for greater savings.
The new law increases subsidies that would fully pay for coverage for people making up to 150% of the federal poverty level ($19,320/annually for an individual, $46,375 for a family of four) for a silver benchmark plan. The Congressional Budget Office calculated that people at that level would, regardless of age, pay no premium as opposed to $800/year currently. For an older person making 450% of FPL, the end of the subsidy cliff brings about $8,000 in savings.
More than 200,000 people signed up for ACA coverage during the first two weeks of the special enrollment period, but between March 1 and March 31, 322,000 people signed up. The response—and the need by people who'd lost insurance because of the pandemic—has been so great that it warranted the extension into August.
"Access to quality, affordable health care is essential—especially as we tackle the COVID-19 pandemic and its aftermath," said HHS Secretary Xavier Becerra in a statement accompanying the release of enrollment figures. "Since the beginning of this Special Enrollment Period's availability on HealthCare.gov, more than 500,000 Americans have already signed up for coverage on HealthCare.gov. Now, thanks to the American Rescue Plan, health care coverage is more affordable and millions of Americans are seeing their premiums reduced. At HHS, we are going to build on the Affordable Care Act (ACA) and work tirelessly to ensure Americans have the chance to sign up for quality, affordable health care coverage that meets their needs."
According to HHS, the nearly 15 million Americans who currently lack health insurance, and many current enrollees, are eligible to receive additional financial support in obtaining marketplace coverage as part of the ARP. An average of four out of five consumers currently enrolled in marketplace coverage can now find a plan for $10 or less per month after financial assistance.
What a difference an election makes.