President Biden is making a final push to build on the Affordable Care Act, extending the enrollment period for marketplace coverage that kicks in Jan. 1 as sign-ups lag.
Why it matters: ACA enrollment has hit new record highs each year of the Biden administration. But those gains are on shaky ground as the Trump administration prepares to take over in January.
- “It’s clearly something that the president sees as one of his major accomplishments of his administration,” said Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms.
- “I think we’ll continue to see until the very last minute that they’re going to be beating the drum to encourage people to get the coverage that they’re eligible for.”
Where it stands: The Centers for Medicare and Medicaid Services said on Monday that consumers can get health coverage for all of 2025 on the federal marketplace through Dec. 18, extending the deadline from Sunday. Enrollment customarily surges in the last few days of the sign-up period.
- Enrollment for coverage that begins in February will continue through Jan. 15. Current marketplace enrollees who don’t change their coverage will be re-enrolled in the same plan, or the most similar one still on the market.
Biden has prioritized growing marketplace enrollment since he hit the presidential campaign trail in 2019.
- 21.3 million people selected an ACA plan for 2024, either through the federal HealthCare.gov site or a state-based marketplace. That beat the previous enrollment record, set the year before, by nearly 5 million, according to Health and Human Services.
- Consumers, on average, will have more choice of insurers for their 2025 coverage, according to KFF. Nearly all HealthCare.gov enrollees will have three or more insurers to choose from for ACA coverage, up from 78% of enrollees with at least three insurer options in 2021.
But the incoming Trump administration is less convinced of the benefits of ACA enrollment.
- While it’s still unclear what changes are in store, Trump in his first term slashed funding for the navigators who help people sign up for coverage and made it easier to buy alternate health insurance that doesn’t comply with ACA standards. Insurer participation in marketplaces hit an all-time low in 2018, during Trump’s tenure.
- The Republican Congress could also decide not to renew enhanced subsidies for marketplace coverage, which have driven enrollment growth over the past few years.
Between the lines: New enrollments in the federal insurance exchange, HealthCare.gov, are trending lower than this time last year, according to the most recent available data from CMS.
- The introduction of enhanced subsidies and then the end of pandemic-era expanded Medicaid coverage boosted marketplace enrollment in recent years. There isn’t a precipitating factor for huge enrollment gains this year, said Cynthia Cox, vice president and director of the ACA program at KFF.
- The presidential election also swamped airwaves that might otherwise have been used to remind people about sign-ups. And new federal efforts to crack down on unscrupulous brokers switching consumers’ coverage without consent could slow down the process for picking a new plan
- CMS did not respond to questions about why open enrollment was extended. But the agency said earlier this month that it’s on track for another record-high number of plan selections during open enrollment this year.
What we’re watching: Whether a few extra days makes a difference in how many people sign up for marketplace coverage.
- Stride Health, an online benefits platform for people without employer-sponsored health insurance, was on track to enroll more people on Monday than it did on Sunday, the original final day of the enrollment period, CEO Noah Lang told Axios.
- “Three days might not seem like a long time, but for a lot of folks, it’s a game changer,” he said