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A record 35 million-plus Americans have health coverage through the ACA. That may be short lived

This includes an estimated 13.6 million people enrolled in policies purchased on the Obamacare exchanges and more than 21 million people in Medicaid expansion coverage, including 16.8 million who were not eligible prior to the landmark health reform law.

Meanwhile, the uninsured rate fell to 8.8% in the fourth quarter of last year, down from 10.3% in the same period of 2020, according to new federal National Health Interview Survey data. That represents about 4.9 million people obtaining coverage.

“With a record-breaking total of over 35 million people who now have health coverage, thanks to the Affordable Care Act, America’s uninsured rate is nearing an all-time low,” Health and Human Services Secretary Xavier Becerra said in a statement.

However, these gains could start melting away as early as this summer if the nation’s public health emergency is not renewed again. That will allow states to resume disenrolling Medicaid beneficiaries who no longer qualify for coverage, a practice that was halted during the pandemic.

Also, the enhanced federal subsidies for Obamacare policies, which have drawn more Americans to the exchanges, are set to expire at the end of this year unless Congress acts.

Growing interest

Even before President Joe Biden took office in 2021, more Americans were signing up for Affordable Care Act coverage as the Covid-19 pandemic put an increased emphasis on access to health care.

Biden then launched a six-month special enrollment period early last year, which allowed people to take advantage of the more generous federal subsidies created by the Democrats’ $1.9 trillion coronavirus relief package. Some 2.8 million people enrolled in Obamacare plans during the period.
The administration also extended the open enrollment period for 2022 coverage by a month and poured funding into marketing, outreach and assistance in picking policies. A record 14.5 million people selected plans, though not all ended up actually enrolling.
Last month, the Centers for Medicare and Medicaid Services launched a special enrollment period for lower-income Americans, most of whom can select plans with no premiums.

In addition, Medicaid enrollment has swelled over the past two years in large part because states have not been allowed to remove anyone involuntarily from coverage during the pandemic in exchange for a more generous federal Medicaid match, under a coronavirus relief package Congress passed in 2020.

Gains at risk

The historic increase in Affordable Care Act and Medicaid coverage may be short lived, however.

Unless Congress acts, the enhanced subsidies will not be available for 2023 policies on the Affordable Care Act exchanges. The Democrats’ plan to extend the provision as part of their Build Back Better spending package was thwarted last year when Democratic Sen. Joe Manchin of West Virginia said he would not support it.

Also, up to 14.4 million people could lose Medicaid coverage if the public health emergency expires after the second quarter of this year, according to the Urban Institute.

The public health emergency currently runs through mid-July. The Biden administration has said it will give states 60 days’ notice of the emergency’s end so they can ramp up their preparations to review residents’ Medicaid eligibility.

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