Record Numbers of Americans Enrolled in ACA Marketplace Coverage for 2022

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ACP is hopeful that Congress will take action before pandemic-era subsidies and tax credits expire at the end of the year

Feb. 18, 2022 (ACP)—The Centers for Medicare & Medicaid Services announced an all-time record high number in late January: 14.5 million Americans have signed up for 2022 health coverage through the marketplaces created by the Affordable Care Act, including nearly 3 million new consumers. And several states still had a couple of weeks of open enrollment left, so the numbers will rise even more.

These numbers are a sign that pandemic-era subsidies and tax credits have made a significant dent in the number of uninsured people. The American College of Physicians is pleased to see this progress and is urging federal leaders to make the financial assistance permanent.

“These remarkable numbers show that if care is available and affordable, people want it,” said Bob Doherty, ACP senior vice president emeritus for governmental affairs and public policy. “But these subsidies expire at the end of 2022 unless Congress takes action.”

ACP believes that “it makes no sense at all to take the higher subsidies away from low-income people who benefitted from them,” Doherty said. “The coverage for millions is at risk.”

But extending the subsidies will be a major political challenge for the Biden administration. “An extension of the subsidies was part of the Build Back Better legislation, which is on hold. We're in a tight fiscal environment, and it's an election year when there's no incentive for Republicans to give President Biden what would be perceived as a victory,” Doherty said.

On the other hand, he said, it is possible that a pared-back version of the bill may pass.

ACP is also closely monitoring efforts to support Medicaid expansion in the 12 states that have refused to provide coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.

The good news is that the number of states without Medicaid expansion continues to dwindle thanks to ballot initiatives. “Voters have taken control of the issue in two of the most conservative states in the country, Oklahoma and Missouri,” Doherty said.

In Missouri, the state began implementing Medicaid expansion last fall after the success of a ballot measure in 2020. According to the Kaiser Family Foundation, “After Governor Mike Parson announced that the state would not implement expansion because the ballot measure did not include a revenue source, individuals who would be eligible for expansion coverage filed a lawsuit against the state. Ultimately, the Missouri Supreme Court ruled that the initiated amendment is valid under the state constitution and that the legislature's budget appropriation authorizes the state to fund expansion coverage.”

And in Oklahoma, officials began to implement Medicaid expansion last summer after the success of a ballot measure in 2020. “Language in the approved measure prohibits the imposition of any additional burdens or restrictions on eligibility or enrollment for the expansion population,” the Kaiser Family Foundation states.

A Medicaid expansion ballot measure is in the works in Florida, and South Dakota voters are slated to consider Medicaid expansion. However, the foundation reports that “to counter the Medicaid ballot initiative, [South Dakota] GOP leaders are promoting a separate measure on the June primary ballot that, if passed, would require 60% voter approval for any new constitutional measures that increase taxes or cost the state $10 million or more.” The Medicaid initiative would qualify for this restriction.

“We're hopeful because of the successes in Oklahoma and Missouri,” Doherty said. “People want more access to health insurance, and it's possible to get this done.”

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Back to the February 18, 2022 issue of ACP Advocate