See update below.
There’s a front page story today which comes from a highly-respected healthcare reporter (Julie Appleby) at a highly-respected healthcare policy data outlet (KFF News)...which has a shockingly bad headline.
The headline declares “Obamacare sign-ups lag after Trump election and legal challenges.”
The implication of this is that ACA enrollment is lower than it was as of the same point a year ago.
This is...wrong.
As the Centers for Medicare & Medicaid Services (CMS) noted on Dec. 20th, the federal ACA exchange, HealthCare.Gov (which hosts 31 states), actually has seen record-breaking enrollment with 16.6 million people being enrolled for 2025 coverage so far. When you add the 2.8 million enrollees reported across 7 of the states which operate their own ACA exchanges (CA, CO, ME, MN, NV, NJ & NM), that’s nearly 19.5 million ACA enrollments for 2025...up 16.6% over the same point a year ago, and up 9% over the 2024 Open Enrollment Period’s final tally.
In fact, when you include the auto-renewal numbers from the remaining 13 states (CT, DC, GA, ID, KY, MD, MA, NY, PA, RI, VT, VA & WA), you get a grand total of at least 22.8 million Qualified Health Plan (QHP) enrollments for 2025 (last year’s final tally was ~21.5 million nationally).
So what’s going on here?
Well, first of all, look at the date on the original KFF News article: It was published on December 19th, a day before CMS issued their press release featuring the 16.6M number.
However, this isn’t just a matter of it being outdated. As I had noted a day earlier (the same day that Appleby’s KFF article ran), 2025 enrollment in CO, ME, NJ, NM & NV was running 24% ahead of the same point in 2024, making it highly unlikely that enrollment would be running behind overall.
So what’s the deal? Well, you have to read the KFF article carefully:
New enrollments under the Affordable Care Act are on pace to trail last year’s record numbers by as many as a million as the outgoing Biden administration confronts upheavals in the program.
...So far, the number of new and returning enrollees using healthcare.gov — the federal marketplace that serves 31 states — is below last year’s. New enrollments were just over 730,000 in early December, compared with 1.5 million at the same time last year.
Again, new and returning enrollees. That doesn’t include the millions of current enrollees who allowed themselves to be automatically re-enrolled for the new year.
I’ve pointed this out repeatedly to any healthcare reporter who cares without much any of them providing clarification.
In any event, once the 2025 Open Enrollment Period wraps up later this month (Jan. 15th in most states; as late as Jan. 31st in a few), I expect total ACA exchange enrollment to reach ~24 million nationally, plus another ~1.8 million Basic Health Plan (BHP) enrollees in MN, NY & OR, for a total of well over 25 million people in ACA policies.
As for why new and active renewals are down while auto-renewals are up, that’s pretty simple:
- A good 5M+ more people enrolled for the first time for 2024 coverage, including several million who transferred over from Medicaid via the post-pandemic Unwinding process, so much of the “low-hanging fruit” of new exchange enrollees has already been picked.
- Most of those millions of current enrollees who are first-timers have, therefore, never gone through the renewal process before; my guess is that a lot of them don’t realize that it’s better to actively log into your account and pick your plan for the new year as opposed to allowing themselves to be passively auto-renewed into their existing policy.
In any event, if you still need healthcare coverage, you can still enroll in every state except Idaho through at least January 15th for coverage starting February 1st.
UPDATE: In response to several of the comments, I need to clarify a couple of things:
- KFF is a non-profit healthcare policy & data organization which HAS NO CONNECTION with the insurance carrier Kaiser Permanente.
- KFF is a stellar resource and does fantastic work on healthcare policy; I use and rely on their data constantly in my own healthcare wonkery work.
- Julie Appleby specifically does excellent work as well, and the article itself is perfectly fine. It’s because of these points that I was so surprised that the headline is so misleading. It’s also important to remember that reporters often aren’t the ones who choose the headlines for their articles.
In other words, I am not trying to trash her or KFF in general here. This is a very rare miss for them. I just want to head off a false narrative at the pass to the extent that I can.
