- The number of Americans with health insurance under Affordable Care Act provisions has reached an all-time high of more than 35.8 million, up from about 31 million in 2021, according to new HHS data released Friday. The data suggest the gains, primarily through Medicaid expansion and ACA marketplace enrollment, are the result of Biden administration policies designed to boost insurance coverage during the COVID-19 public health crisis, HHS said.
- The coverage expansion helped keep the rate of uninsured Americans stable and near record lows, at 8.8% in the fourth quarter of 2021 vs. 8.9% in the third quarter and 10.3% in the fourth quarter of 2020, the report from HHS' Office of the Assistant Secretary for Planning and Evaluation said. The data are based on results from the National Health Insurance Survey.
- The success in expanding insurance to more Americans during the pandemic, however, comes as health policy experts warn those gains could be rolled back when marketplace subsidies expire and states resume Medicaid eligibility determinations once the public health emergency lifts.
The decline in the U.S. uninsured rate corresponds with about 4.9 million Americans gaining health coverage since the end of 2020. A record 14.5 million people signed up for coverage through the ACA exchanges for 2022.
Of the more than 35 million people with ACA-related insurance in early 2022, about 21 million obtained coverage due to the expansion of Medicaid to low-income adults aged 65 and under in more than 40 states and territories. Minnesota and New York also implemented the Basic Health Program option under the ACA to cover people with incomes between 138% and 200% of the federal poverty level.
HHS Secretary Xavier Becerra said the success of Medicaid expansion nationwide offers a path to affordable care for the 12 states that have yet to expand their Medicaid programs. "We will continue to push for comprehensive ACA coverage and Medicaid expansion and work with states to make comprehensive health care accessible and equitable for families across the country," Becerra said in a statement.
Legislative and administrative actions since 2021, in addition to the economic recovery, have likely contributed to the increase in Americans with health insurance coverage during the pandemic, the ASPE report said.
Those efforts included an extended 2021 marketplace enrollment period, stepped up consumer outreach and enrollment efforts, the passage of the American Rescue Plan, two states — Oklahoma and Missouri — adopting ACA Medicaid expansions and the Medicaid continuous coverage provision under the Families First Coronavirus Response Act.
The ARP removed the income cap on eligibility for marketplace premium tax credits and lowered the required premium contribution for consumers who were already eligible for the credits. The expanded subsidies began in 2021 and continue through the end of this year.
The Families First Act required states to suspend Medicaid eligibility terminations, starting in March 2020, and maintain coverage for nearly all existing enrollees. The continuous coverage requirement was a primary driver behind Medicaid enrollment growth during the pandemic, the report found.
The COVID-19 public health emergency has been extended until July 15, but when it expires, states will restart the process of checking eligibility of Medicaid enrollees.
CMS Administrator Chiquita Brooks-LaSure said an estimated 4 million additional people could gain coverage if Medicaid is expanded in all states. "Medicaid expansion is key to improving maternal and infant health outcomes, addressing long-standing health disparities, and connecting people to needed essential care," she said. "We can't leave them behind."