For the third straight year, enrollees in the Affordable Care Act (also known as Obamacare) have broken records. Texas is, by far, the state with the most customers, new and returning.
President Joe Biden spoke on Wednesday about the new numbers from the Centers for Medicare and Medicaid Services (CMS). With just over a week to go, total enrollment in the ACA has broken 20 million. This is the third year in a row that the number has shattered the previous year’s record.
“Today, we hit a major milestone in lowering costs and ensuring all Americans have access to quality, affordable health care: a record-breaking 20 million Americans have enrolled in health care coverage through the Affordable Care Act marketplaces,” President Biden said. “With six days left to still get covered, 8 million more Americans have signed up for ACA coverage than when I took office.”
On the CMS website, the enrollment is broken down by state. The state with the most enrollees during the 2024 open enrollment period is Florida with 4,034,546. Next is Texas with 3,291,543. From there, it’s a long way to third place, California, with 1,733,137.
Florida and Texas would likely have even higher numbers if either state had accepted the ACA Medicaid expansion. The 2010 law set the national standard for Medicaid at four times the federal poverty rate and used federal dollars to cover more than 90 percent of the extra cost for states. The Supreme Court upheld the overall constitutionality of the law but struck down the mandate that states had to change their Medicaid threshold. Since then, only 10 states have not accepted the ACA deal, including Texas and Florida.
Because of the wording in the ACA, this leaves a gap between Medicaid accessibility and subsidies provided for poor Americans purchasing health insurance through HealthCare.gov, the federal marketplace. Estimates from experts show that between 1 and 2 million Texans are being denied coverage because of this gap.
Enrollment has soared under the Biden Administration, which earmarked $100 million for extra navigators to help Americans access the marketplace and find the best deal for their coverage as part of the Inflation Reduction Act. Unlike his predecessor, Biden has aggressively marketed the ACA to Americans, increasing enrollment consistently.
Another reason for Texas’s high enrollment is likely due to the huge numbers of disenrollment in Medicaid. During the COVID-19 pandemic, rules about continuing coverage were relaxed in order to help fight the ongoing health crisis. Those protections were phased out earlier this year.
In Texas, the result has been catastrophic. More than a million residents, most of them children, lost their coverage. State resources have been overwhelmed, leading to whole families falling through the cracks.
In this regard, the news of so many Texans finding affordable coverage through the federal marketplace is welcome. However, it underscores how much refusing to accept the Medicaid expansion continues to hurt the most vulnerable Texans.
Open enrollment ends Jan. 16. To sign up, go to https://www.healthcare.gov/.