Yesterday, the Centers for Medicare and Medicaid issued a press release stating that ACA enrollment during Open Enrollment 2023 is just about 16.3 million people enrolled on the marketplaces. It is a record that beats 2022 which had beaten 2016
The Centers for Medicare & Medicaid Services (CMS) reports that 16.3 million Americans have signed up for 2023 individual market health insurance coverage through the Marketplaces since the start of the 2023 Marketplace Open Enrollment Period (OEP) on November 1, 2022 through January 15, 2023. This includes 12.2 million plan selections in the 33 Marketplaces using the HealthCare.gov platform for the 2023 plan year, where the OEP ran through January 15, 2023, and 4.1 million plan selections in the 18 State-based Marketplaces (SBMs) in 17 states and the District of Columbia that are using their own eligibility and enrollment platforms, through January 15, 2023, which represents the end of the OEP for many SBMs
There is one massive upside factor for the ACA in 2023 that was not present in 20216. Subsidized plans are way cheaper. Subsidized Silver plans are way cheaper because of the combination of higher subsidies for a given income level and the removal of income caps for subsidy eligibilty due to the combination of the American Rescue Plan and then the Inflation Reduction Act. Not Silver subsidized plans are substantially cheaper due to Silverloading when CSR payments were stopped in 2017.
There is a massive downwards pressure on ACA enrollment since 2016. Medicaid Expansion has become much more common. Individuals who earn between 100% to 138% Federal Poverty Level (FPL) are eligible for either Medicaid or high value subsidies on the Exchanges. If a state expands Medicaid, these folks go to Medicaid. The under 150% FPL group is a very large group so the 100-138% group which faces zero premium plans is a huge source of enrollment. That pool has shrunk over time.
There are probably differences on partisan take-up. Actively opposing the ACA is not a core performative element of being conservative in 2023 while it was in 2016 and 2017. This may help boost enrollment. We have also seen navigator funding and advertising get flipped back on after substantial reductions or eliminations during the Trump Administration but those elements were humming at the end of the Obama Administration.
There is still a couple of days of enrollment left for a few State Based Marketplace states, so I would not be surprised if the final number for the end of the OEP is closer to 16.4 million rather than 16.3 million, but these are some of the factors at play right now on enrollment.