After the 2024 open enrollment period for Obamacare ended, President Joe Biden boasted that 21.3 million people signed up for health insurance on the government exchanges, an increase of 30 percent over 2023, and nine million since he took office, in a statement on January 24.
“It’s no accident,” stated Biden. “My actions to protect the Affordable Care Act and lower premiums continue to make a big difference. And the American people have made it clear: they don’t want the Affordable Care Act weakened and repealed—they want it strengthened and protected.”
Nearly Half Covered Free
Biden credited “lower premiums,” health insurance that doesn’t penalize patients for pre-existing conditions, and charging enrollees the same rates regardless of sex, but did not mention how much the government subsidizes premiums, the tax credits offered to families whose income exceeds 400 percent of the federal poverty level (FPL), or the narrowed access to doctors over the years to control plans’ costs.
“Many of the new enrollees are likely people who did not enroll when the premium was 2 to 4 percent of their income but do when coverage is given to them for free,” said Theo Merkel, a senior research fellow at the Paragon Health Institute.
A graph in a post by Merkel shows nearly half of the exchange enrollees live below 150 percent of the FPL. Those enrollees pay zero for the benchmark plan. Premiums for an unsubsidized Obamacare plan can cost $5,628 for a 40-year-old adult.
States Disenroll Medicaid Ineligibles
States are “unwinding” Medicaid enrollment after a pandemic-era moratorium on removing individuals from the program ended in 2023.
“Biden’s real accomplishment was failing to return to Medicaid eligibility rules in an orderly fashion after the health ‘emergency’ (which stopped being a real emergency at least a year before the administration finally gave it up),” said Joseph Antos, a senior fellow in health care at the American Enterprise Institute.
“On the one hand, Biden complains about states disenrolling millions of people from Medicaid,” said Antos. “On the other hand, he crows about signing many of the same people for free Obamacare.”
Three-Year Trend
Antos notes that open enrollment counts jumped about two million a year in 2022 and in 2023, after a period of constant enrollment. “The blip in exchange enrollment during the 2024 open enrollment period should be averaged over 3 years—without keeping so many people on Medicaid despite no longer qualifying, there would be no surge in ACA enrollment,” said Antos.
The surge in enrollment began in 2022 when premium subsidies increased, says Antos.
“The bump this year is a combination of Medicaid disenrollments, and additional people moving to ACA coverage because it is essentially free (that is, zero premium, net of subsidy) for many of them,” said Antos. “So next year’s enrollment may increase somewhat because of the premium subsidy effect, although I think that effect will be low.”
A change in enrollment will provide an opportunity for political spin. “If a Republican wins [the presidency] this year, Democrats will complain about the ‘shocking’ drop in additional ACA enrollment in the next open-enrollment period—the result of returning to normal patterns,” said Antos.
AnneMarie Schieber (amschieber@heartland.org) is the managing editor of Health Care News.
