The Washington Post

Nearly 3 million people bought ACA health plans during a six-month extended sign-up period.

- BY AMY GOLDSTEIN amy.goldstein@washpost.com

About 2.8 million people signed up for Affordable Care Act health plans during an unpreceden­ted six-month special enrollment period that President Biden ordered to help Americans find insurance coverage during the coronaviru­s pandemic, according to figures his administra­tion released Wednesday.

The additional participan­ts push the enrollment in ACA health plans to 12.2 million, the highest level since the insurance marketplac­es created under the law first offered health plans in 2014.

The enrollment tally — along with a raft of figures illustrati­ng that such health plans are affordable for many people — was released as the president is pressing Congress to make permanent a temporary upgrade in federal subsidies for ACA plans that began early in the spring as a provision of a pandemic relief law.

The final tally, for the sign-ups from mid-february through mid-August, shows that demand for ACA health plans in the six months was far below the 8.2 million consumers who chose health plans during the most recent regular enrollment period, which took place during six weeks late last year.

Biden pointed to the record total number of enrollees in a statement accompanyi­ng the figures Wednesday, saying Americans who have taken advantage of the special enrollment he ordered “will have more security, more breathing room, and more money in their pocket if an illness or accident hits home.”

The enrollment report, compiled by the Department of Health and Human Services, also shows that in three dozen states relying on the federal insurance marketplac­e Healthcare.gov, sign-ups were nearly three times greater than the number during special enrollment­s last year and almost four times greater than in 2019.

Before the Biden administra­tion threw the doors wide open, consumers had been allowed to sign up outside the regular, yearly enrollment time only if they had a substantia­l change in their life, such as a birth, a move or a job loss. Under President Donald Trump, who opposed the health-care law, health officials tightened the rules.

Even before Biden created the six months of special enrollment, Americans who became unemployed during the pandemic would have qualified to enroll.

But administra­tion officials have pointed out that such people would have needed to apply for permission and that many did not know they could ask. In addition, administra­tion officials have said the ACA plans were not as affordable for many people until a relief law enacted in March, dubbed the American Rescue Plan, enhanced the tax credits that help most people with ACA coverage pay monthly premiums.

Wednesday’s report shows that 2.1 million people signed up for new coverage in those states that use Healthcare.gov. In addition, more than 700,000 signed up in 15 states that run their own marketplac­es under the ACA. Some of the state-run marketplac­es had opened their doors in 2020, soon after the pandemic began, and several have continued.

The 2010 health-care law that created the insurance marketplac­es designed them for people unable to get affordable health benefits through their employment.

Enrollment in ACA health plans has never been as high as was predicted at the outset, when government forecasts anticipate­d that within a few years, 24 million people would buy their insurance through the marketplac­es. But Biden has been pressing to extend the reach of the marketplac­es — and to draw attention to the effects of his efforts. Unlike some Democrats who sought the presidency in 2020 arguing for an expanded role for public insurance, Biden has always embraced the health-care law as the main tool for improving the nation’s healthcare system.

And he is urging Congress to build on the law as Democratic lawmakers are debating healthcare changes and other safety-net expansions through a budget reconcilia­tion process.

Chiquita Brooks-lasure, administra­tor of the Centers for Medicare and Medicare Services, the agency within HHS that oversees the ACA marketplac­e, noted that the administra­tion is preparing to devote $80 million in grants to enrollment helpers called navigators. That will be the most ever spent and reverses years of cuts by Trump health officials who contended that such enrollment support was ineffectiv­e and unnecessar­y.

“Really trying to make sure people know of their options makes a huge difference,” Brooks-lasure said.

The administra­tion used the figures released Wednesday to highlight that the decision to open the marketplac­es this year has fostered the president’s goal of helping to insure racial and ethnic groups hit hardest in the pandemic. The proportion of Black and Hispanic people who signed up for ACA health plans appears to have been a bit greater than through the limited special enrollment­s of the past two years, although health officials note that a significan­t share of the people who purchased plans did not identify their race or ethnicity.

The figures also show that the proportion of special enrollment­s among people with middle-class incomes remained small but rose from 2 percent last year to 7 percent during this year’s six-month window. For the first time, the upgraded ACA subsidies allowed tax credits for people with incomes above 400 percent of the poverty level — about $51,000 for a single person, or $106,000 for a family of four.

This and other subsidy expansions are to last two years, unless Congress extends them.

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