Obamacare sign-ups hit record 21.3 million as Biden pushes his efforts to lower health care costs

A record 21.3 million Americans flocked to Affordable Care Act coverage for 2024, further cementing the law’s place in the nation’s health care landscape.

Nearly 5 million more people signed up for Obamacare policies for this year compared with last year, the Centers for Medicare and Medicaid Services, which oversees the Affordable Care Act marketplaces, said Wednesday. Notably, about a quarter of people selecting plans were new consumers.

“Part of it is a really simple recipe – let people know you got the best deal in town,” Health and Human Services Secretary Xavier Becerra told CNN in an exclusive interview, noting that 4 out of 5 people can find plans with premiums of $10 a month or less after federal subsidies.

The hefty jump in sign-ups comes as the landmark health reform law’s future once again becomes a presidential campaign talking point.

Former President Donald Trump, who is running for the 2024 Republican presidential nomination, has revived his promise to repeal Obamacare, saying it “sucks.” He vows to replace it with a better plan but has yet to unveil one.

Trump’s declaration has given President Joe Biden the opportunity to tout his efforts to strengthen the law as one way he’s trying to lower health care costs. The president has taken several steps to enhance Obamacare’s appeal, including beefing up federal premium subsidies through 2025 and allowing more families to qualify for assistance.

“The American people have made it clear: they don’t want the Affordable Care Act weakened and repealed – they want it strengthened and protected,” Biden said in a statement Wednesday.

The explosion in interest in Obamacare policies would make it harder for Trump to dismantle the health reform law, as he and congressional Republicans unsuccessfully tried to do after he took office in 2017. Only about 12.2 million people signed up for Affordable Care Act coverage during that open enrollment period. (Consumers are not considered enrolled until they pay their first month’s premium.)

“It would be politically very, very risky to tell all those people that you are going to take away the source of affordable coverage that they’re depending on,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, which funds health care research and grants. “It’s a very significant number of people. You can’t take away that coverage and replace it with nothing.”

States see big gains

Several states, including many led by Republicans, saw massive jumps in sign-ups. In West Virginia, plan selections soared by around 80%, and in Louisiana by roughly 76%. Obamacare proved very popular in the two states with the highest number of plan selections: Texas and Florida, where 1.1 million and nearly 1 million more residents picked policies, respectively.

The number of people signing up is likely to tick up a little more since open enrollment is continuing through January 31 in four states and Washington, DC, which all run their own exchanges.

The increases kept many navigator groups, which help people pick policies, very busy.

At the United Way of Metropolitan Dallas, 34 navigators helped up to 120 residents select plans each week during this open enrollment season, which ran from November 1 through January 16, said Daniel Bouton, vice president for health and wellness at the nonprofit group. That compares with around 90 people a week during the prior open enrollment period.

During its busiest week, ahead of the December 15 deadline to start coverage on January 1, United Way navigators fielded more than 350 appointments, up from around 250 appointments a year ago.

To handle the increased demand with the same number of navigators, the United Way had to temporarily stop working with clients who needed assistance enrolling in Medicaid. Instead, it shifted them to other groups in the community that could help them.

One thing that may be contributing to the increase in Obamacare enrollment is the tidal wave of low-income Americans who are losing Medicaid coverage. States were allowed to start terminating the coverage of residents they deemed ineligible last April after a Covid-19 pandemic relief provision expired. Nearly 15.8 million people have been disenrolled so far, according to KFF, formerly the Kaiser Family Foundation.

Navigators at Florida Covering Kids & Families have been reaching out to those who have lost their Medicaid coverage by phone and email to see if they are interested in signing up for Affordable Care Act policies. Low-income enrollees are eligible for federal subsidies that greatly reduce their premiums and out-of-pocket costs.

“They’re happy to get into the ACA coverage because while it’s not free like Medicaid, it still has been reasonable for them,” Xonjenese Jacobs, director of Florida Covering Kids & Families, said, noting that navigators saw “a pretty steady flow” of former Medicaid enrollees signing up for Obamacare plans.

At Covering Central Florida, navigators have helped about 12% more people select plans between November and mid-January compared with November through January a year ago, said program manager Lisa Reineck. She attributes the boost to an increase in advertising, particularly on television and the radio.

The new customers helped by her team of 17 navigators, who sometimes had appointments until midnight, ranged from young adults who were uninsured or who could no longer stay on their parents’ plans after turning 26 to retirees who were a few years shy of qualifying for Medicare.

“The advertising was huge this year and made a big difference in people saying, ‘Hey, I can really get this for $10 a month? You gotta be kidding me. I need to check this out,’” said Reineck. “And then they reached out and they found out, yes, it was a reality for many, many people.”

The Centers for Medicare and Medicaid Services said it is being more targeted in its marketing efforts so it reaches people who need health coverage, Chiquita Brooks-LaSure, the agency’s administrator, told CNN in an exclusive interview. It is advertising on HGTV, “Shark Tank,” Telemundo, The Weather Channel and sports programs, among others.

“It’s all about making sure that people who are hearing about us and seeing themselves as someone who might be able to find affordable coverage if they go to healthcare.gov,” she said of the federal exchange.

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