Jan 24, 2024 - Health

ACA enrollment surged in red states this year

Change in Affordable Care Act enrollment, 2023 to 2024
Data: Centers for Medicare and Medicaid Services; Map: Axios Visuals

A record 21.3 million people signed up for health insurance on the Affordable Care Act marketplaces this year, with the largest enrollment increases tallied in red states.

Why it matters: The 30.7% annual increase in ACA sign-ups comes as former President Trump's renewed calls for repeal have again raised doubts about the law's future.

  • Enrollment figures released by federal health officials on Wednesday indicate that Republican-leaning states would be heavily affected by the law's repeal.

By the numbers: States with the largest year-over-year increase in sign-ups include West Virginia (80.2%), Louisiana (75.9%), Ohio (62.2%), Indiana (59.6%) and Tennessee (59.5%), according to data from the Centers for Medicare and Medicaid Services, which oversees the marketplaces.

  • Seven other states saw increases of 45% or more: Mississippi, Arkansas, Alabama, South Carolina, Georgia, Arizona and Texas.
  • Enrollment in Texas increased by just over 1 million to 3.5 million. In Florida, enrollment increased by just shy of 1 million to 4.2 million, the most of any state.
  • Enrollment decreased only in Maine (-2.6%) and Washington, D.C. (-1.4%).
  • Almost a quarter of enrollees were new to the marketplaces this year.

Zoom in: Some of the enrollment surge can likely be attributed to a portion of the millions who've recently lost Medicaid coverage moving to the marketplaces.

  • Democrats also made marketplace subsidies larger and available to more people, though the enhanced assistance is set to expire after 2025 without an extension from Congress.
  • The Biden administration also boosted enrollment outreach and closed a "glitch" in the law that kept some families from accessing subsidies.
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