off the charts
POLICY INSIGHT
BEYOND THE NUMBERS

HealthCare.gov Enrollment Climbs With Biden Administration Actions

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Director of Health Insurance and Marketplace Policy

Since the start of special enrollment February 15, more than 1.2 million people have enrolled in insurance at HealthCare.gov and another 330,000 have been assessed or determined eligible for Medicaid through the federal enrollment gateway. This surge reflects the Biden Administration’s recognition that swiftly granting a special enrollment period was necessary in a time of health and economic uncertainty, its campaign to promote awareness of the period and enrollment options, and the American Rescue Plan’s substantial financial aid to help people afford coverage.

The period will last until August 15, allowing anyone to enroll without having to meet special rules such as the recent loss of other health coverage. In addition to this long enrollment period, the Biden Administration has run a $100 million advertising campaign and provided an additional $2.3 million in funding for navigators, which provide one-on-one help and raise general awareness about available coverage and subsidies to help people afford it.

The stopgap 20 percent navigator funding boost for the remainder of the year is a sharp turn from the deep cuts to that program and other actions the Trump Administration took to sabotage Affordable Care Act (ACA) enrollment. From its first year the Trump Administration cut advertising, marketing, and enrollment assistance through the navigator program. It also imposed policies such as stricter verification requirements for people seeking coverage during the year. Roughly 1.3 million fewer people enrolled in 2020 than in 2017, the last enrollment period under the Obama Administration.

The recent surge in enrollment numbers is also likely due to the substantial tax credit assistance the American Rescue Plan is providing to help people afford insurance premiums. Since April, the first month lower premiums were available, more than 2.3 million current enrollees have returned to HealthCare.gov to claim their discounts. More than 1 million new and returning enrollees selected a plan that cost $10 or less per month, after accounting for financial assistance.

With the Rescue Plan’s premium tax credit assistance, for example, a family of four that was previously paying premiums of $252 is now eligible for comprehensive health insurance for a $67 monthly premium, an annual savings of $2,220. Additional discounts will come online in July, when people who receive unemployment benefits in 2021 can enroll in a “benchmark” silver plan with generous cost-sharing assistance without any upfront premium. (People who don’t claim their new premium discount during the year can get money back when filing their 2021 tax return.)

The Biden Administration’s 2022 proposed budget pledges to make permanent these premium tax credit enhancements, which expire at the end of 2022. It also calls on Congress to address high out-of-pocket costs in marketplace plans and extend coverage to the lowest-income people in states that have refused to expand their Medicaid program under the ACA, which particularly affects people of color. Policymakers should act on these calls.

Already the next open enrollment period this fall is poised to build on the record 27-million-plus people who were enrolled due to ACA coverage expansions as of February. In addition to continued lower premiums in 2022 and a commitment to robust federal marketing, the Centers for Medicare & Medicaid Services will award a record $80 million to navigators, prioritizing groups that primarily serve people in communities of color and other people who are more likely to be uninsured. Applications are due July 6.

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