Biden Touts Obamacare Coverage of Almost 50 Million in a Decade

Nearly 50 million people have had individual health insurance coverage through the Affordable Care Act marketplaces since they began operation in 2014, the Biden administration announced Tuesday.

After a record 21.3 million people signed up for 2024 marketplace coverage, an all-time high of 20.8 million had an active policy and paid their premium as of February 2024, according to an analysis by the Treasury Department.

“The Affordable Care Act is more popular than ever, and Affordable Care Act coverage is more affordable than ever,” President Joe Biden said in a statement.

Biden said he and Vice President Kamala Harris had lowered costs for ACA coverage by an average of $800 per year, invested in outreach and in-person assistance, and eliminated red tape.

The Treasury research came ahead of the Census Bureau’s release of household income, poverty, and health insurance figures for 2023 from the Current Population Survey.

The new data reflects the Biden administration’s efforts to protect and strengthen the ACA, White House domestic policy adviser Neera Tanden said during a Monday afternoon media briefing. Marketplace enrollment has increased 75% during the Biden-Harris administration, Tanden said.

“That’s 9 million people who now have health insurance through the marketplaces, more than ever before,” Tanden told reporters.

Individuals that can’t get health care through their employers can purchase comprehensive, individual coverage through the ACA marketplaces. Strong ACA marketplace enrollment growth in recent years has been driven by expanded premium tax credits—under the American Rescue Plan Act in 2021 and the Inflation Reduction Act in 2022—that helped pay for coverage.

The 2021 law increased ACA premium tax credits and expanded eligibility for the subsidies to people earning above 400% of the federal poverty level for 2021 and 2022. The IRA continued those expanded subsidies through 2025. But the IRA tax credits are slated to expire at the end of 2025 unless funding is renewed by Congress. Republicans strongly oppose the ACA and re-funding the tax credits.

“The ACA marketplace is part of the fabric of the American health-care system,” Tanden said. “And it is a crucial reason we have historic levels of insurance coverage in our country. It also underscores just how damaging congressional Republicans’ plan to repeal and undermine the ACA would be.”

The Treasury report used IRS data to examine marketplace usage by state and by a variety of demographic markers, said Aviva Aron-Dine, Treasury’s acting assistant secretary for tax policy.

“One takeaway that jumped out from the numbers” is that the share of people that obtained marketplace coverage is higher in states that have not expanded eligibility for Medicaid coverage under the ACA, or only did so recently, Aron-Dine said.

Among people earning roughly $60,000 or more—400% of the federal poverty level—those ages 50 and over will likely experience the greatest cost-savings from the health-care tax credits, according to separate research released Monday by the Urban Institute, with funding support from the Robert Wood Johnson Foundation.

The tax credits lowered average premiums by 57% for 60-year-olds and 60% for 64-year-olds, who saw an average credit of $654 per month, the Urban Institute reported.

“However, if the enhanced credits are allowed to expire after 2025, many Marketplace enrollees, particularly older adults and those in high-cost states, would face extremely high out-of-pocket premiums forcing many out of coverage,” said a statement from Jessica Banthin, senior fellow at the Urban Institute.