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Record ACA Enrollment Tops 21.3M, and Counting...

Analysis  |  By John Commins  
   January 25, 2024

The total could grow as four states and Washington, D.C. continue enrollment through Jan. 31.

The Affordable Care Act is more popular than ever, with a record 21.3 million people signing up on the landmark law's Health Insurance Marketplace during the federal open enrollment period, the Centers for Medicare & Medicaid Services says.

The latest enrollment figures represent a 31% increase over the 16.3 million people enrolled in 2023. That record participation could grow within the next week because enrollment in four states and the District of Columbia continues through Jan. 31, CMS says.

Total plan selections so far include more than five million new enrollees, representing about 25% of total plan selections this year, and 16 million people who renewed coverage, CMS says.  

HHS Secretary Xavier Becerra says the record enrollment shows that "the ACA continues to be a successful, popular, and important federal program to millions of people and their families."

"For decades, when it came to federal programs we could depend on to keep Americans covered, three were always top of mind — Medicare, Medicaid, and Social Security, but now it's crystal clear that we need to add a fourth — the Affordable Care Act," Becerra said.

The Biden Administration is crediting subsidies and policies provided in the Inflation Reduction Act and the American Rescue Plan that keep premiums affordable. Because of that, HHS says, "four in five customers were able to find health care coverage for $10 or less per month for plan year 2024 after subsidies."

The White House also designated $100 million to hire and train more "navigators" to help consumers find coverage.

Compared to the 2023 open enrollment, nearly 4.2 million more people with household incomes less than 250% of the federal poverty level (about $75,000 per year for a family of four) enrolled in 2024 coverage. As of December 31, 2023, CMS data show that 2.4 million plan selections in states that use, or approximately 15%, were made by people previously enrolled in Medicaid or Children's Health Insurance Plan.   

The federal open enrollment period ran from Nov. 1, 2023, to Jan. 16, 2024, for states using the platform. Although the open enrollment has ended, people who qualify for Medicaid or CHIP can enroll year-round. For those no longer eligible for Medicaid or CHIP, a special enrollment period is available to enroll in Marketplace coverage.

Additionally, people with household incomes less than 150% of the federal poverty level ($22,000/year for a person and $45,000/year for families of four) can enroll in Marketplace coverage anytime through a special enrollment period. Consumers who experience a change of life circumstance — such as marriage, birth, adoption, or loss of qualifying health coverage — may also be eligible for a special enrollment period.

President Barak Obama created the ACA and signed it into law in 2010.

Red States Embrace 'Obamacare'

The biggest enrollment growth so far has been in Republican-leaning states, some of which have rejected Medicaid expansion and / or cut their Medicaid rolls, CMS data show.

West Virginia saw the largest year-over-year enrollment increase of 80.2%, followed by Louisiana (75.9%), Ohio (62.2%), Indiana (59.6%) and Tennessee (59.5%). In addition, Mississippi, Arkansas, Alabama, South Carolina, Georgia, Arizona and Texas saw enrollment growth of at least 50%. In Florida, 4.2 million people signed up for health insurance, up from one million in 2023 and the most of any state. Only Maine ( -2.6%) and Washington, D.C. ( -1.4%) saw enrollment drop this year.

Despite the popularity of the ACA, it continues to be a hot button political issue. Former President Donald Trump, the likely GOP presidential nominee, failed to kill the ACA during his term in office, but he has pledged repeatedly to replace the ACA, which he has called "a disaster."

"I don't want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!!" Trump wrote in a November 2023 post on Truth Social.

However, Trump has never provided details on what his plan would look like.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


The latest enrollment figures represent a 31% increase over the 16.3 million people enrolled in 2023.

The total includes more than five million new enrollees, representing about 25% of total plan selections this year, and 16 million renewals.

The largest enrollment growth is in Republican-leaning states, some of whom have declined to expand Medicaid or pared their Medicaid rolls.

Former President Donald Trump has repeatedly pledged to dismantle the ACA if he is re-elected in November.

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