The Affordable Care Act’s open enrollment period, which begins today, is expected to see a brisk pace of sign-ups, with consumers receiving more federal financial assistance to cushion them from higher premiums next year.
Enrollment will be open from Nov. 1 to Jan. 15 in the 33 states that use the federal marketplace HealthCare.gov, while sign-up periods vary in states that run their own exchanges. Consumers must enroll by midnight on December 15 for coverage that begins on January 1 on the federal exchange, where they can obtain coverage and learn if they are eligible for subsidies.
Enrollment in ACA plans has increased dramatically under President Biden, who campaigned on bolstering and expanding on the 2010 Obama-era law. The administration and Democrats in Congress have taken a number of steps to broaden eligibility and subsidies. According to the Department of Health and Human Services, 2.8 million more consumers will receive financial assistance for their premiums through the ACA in 2022 than in 2021.
According to the Kaiser Family Foundation, nearly 17 million people had individual market coverage as of early 2022, the highest enrollment since 2016. This is an increase from around 14 million people in early 2020.
Since its inception in 2010, the ACA has been a source of contention. Republicans claim that the law’s requirements have raised premiums and that Congress’ recent expansion of consumer subsidies is overly generous, fueling inflation. Democrats claim that the ACA has successfully reduced the uninsured rate in the United States and made healthcare more accessible and affordable for Americans.
Congressional Republicans fought unsuccessfully to repeal the law in 2017, and three legal challenges were filed with the U.S. The Supreme Court stopped short of completely repealing the law. Some of the more contentious aspects of the ACA, such as the penalty for not having health insurance, were repealed in court rulings and by Congress.
The Trump administration prioritized undermining the ACA by reducing funding for outreach and suspending insurer subsidy payments. Democrats in Congress and the administration have worked to reverse the trend.
HHS announced in August that it would invest $98.9 million in grants to organizations that assist consumers in enrolling in ACA plans, the single largest such funding award to date. This compares to the $10 million invested by the Trump administration in funding the groups for the 2018 open enrollment season.
Legislation passed in August expanded and extended premium-coverage subsidies through 2025. Subsidies were increased in 2021 but were set to expire.
Individuals may also be eligible for financial assistance if they earn more than four times the federal poverty level, which is approximately $54,000 for an individual and $110,000 for a family of four. Previously, people earning more than four times the poverty line were ineligible for subsidies.
In addition, a Biden administration rule issued in August means that families with at least one employee-provided health insurance will find it easier to qualify for ACA subsidies. According to the administration, the change will result in approximately 1 million Americans gaining coverage or having their insurance become more affordable.
Some opponents of the health-care law argue that the more generous and expansive subsidies are misguided because they will cost the federal government $30 billion in 2022, contributing to inflation while providing no incentive for insurers to lower premiums.
“The majority of the new subsidy amount goes to people who already have coverage and are already receiving a very large subsidy,” said Brian Blase, president of the Paragon Health Institute and a special assistant for health policy in the Trump administration. “This is all very inflationary.” It increases government spending while crowding out the private sector.”
The Biden administration and public-health officials anticipate that more people will sign up for coverage during the open enrollment period.
“Americans have been dealing with the pandemic, so they want coverage,” said Leslie Dach, founder and chair of Protect Our Care, a group that advocates for the ACA’s preservation. “People understand it’s good insurance. It’s a better, less expensive product.”
Premiums are expected to rise in 2023, owing to higher labor costs and increased demand for healthcare services. However, most consumers who purchase ACA plans through the federal and state exchanges will not pay more. The more generous subsidies passed by Congress will protect the majority of people from the full financial impact.
According to a Kaiser Family Foundation survey of 72 insurers, the median monthly premium increase will be 10%. According to HHS, four out of every five customers will be able to find a plan for $10 or less per month after subsidies.