HHS: ACA coverage expands to record 35M people as more states expand Medicaid

A record 35 million people have gained coverage via the Affordable Care Act, either through exchange coverage, Medicaid expansion or basic health coverage, a new federal report shows. 

The report (PDF), released Friday by the Department of Health and Human Services' (HHS) Assistant Secretary for Planning and Evaluation, illustrates the impact of key policies under the American Rescue Plan (ARP) Act, including enhanced ACA exchange subsidies. The total is an increase compared to the 31 million the agency reported last year.

“We will continue to push for comprehensive ACA coverage and Medicaid expansion and work with states to make comprehensive healthcare accessible and equitable for families across the country,” said HHS Secretary Xavier Becerra in a statement. 

The report showed that new estimates from the National Health Interview Survey showed the uninsured rate in the fourth quarter of 2021 was at a near all-time low of 8.8%. The rate is a slight decline from the 8.9% for the third quarter of last year. Overall, nearly 5 million people got coverage since the end of 2020.

The data—based on results from the National Health Insurance Survey through the end of 2021—suggest several policies driving enrollment growth.

Chief among them was a boost to income-based ACA exchange subsidies under the ARP.

“The ARP substantially increased availability of zero- and low-premium health plans for both current enrollees and uninsured adults,” the report said. 

The latest open enrollment had 14.5 million people sign up for coverage for 2022, a record-setting amount. 

However, the subsidies are going to expire after this year. Democrats in Congress are hoping to extend them before that happens. 

Several other policies that led to coverage gains could also go away this year. These include a requirement that states suspend any eligibility terminations for residents on Medicaid. The eligibility requirement will only last through the duration of the COVID-19 public health emergency. Becerra recently extended the emergency through July, but it may not be extended again. 

But other drivers of coverage are not linked to the pandemic. Two states—Oklahoma and Missouri—expanded Medicaid in 2021, and several others expanded coverage under the ACA in 2019 and 2020.

The Centers for Medicare & Medicaid Services and states also joined forces to create multiple strategies and flexibilities for continuing Medicaid and Children’s Health Insurance Program operations such as expedited enrollment.