ACA Sees Record Enrollment, Gets Much-Needed Improvements

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With the start of open enrollment for 2023 this week, ACP offers resources for members to help their patients navigate the ACA Marketplace enrollment process

Nov. 4, 2022 (ACP) — As 2023 approaches, the Affordable Care Act is undergoing improvements: Increased premium subsidies have been extended, the “family glitch” in premium subsidies has been repaired, and ACA plans are seeing record enrollment.

According to the Kaiser Family Foundation (KFF), an estimated 16.9 million people enrolled in the ACA with individual market coverage as of early 2022. “We've seen record enrollment in ACA plans this year, which suggests that more Americans are gaining access to health care,” said Shari Erickson, ACP chief advocacy officer and senior vice president. “There's even more opportunity for growth, and our members can play an important role by giving patients the information they need.”

ACP strongly supported key provisions in the Inflation Reduction Act, which the president signed in August after it was approved by Congress. This legislation extended increased subsidies for ACA Marketplace plans through 2025. “As a result, more Americans will be able to afford to maintain or start coverage,” Erickson said.

As KFF noted, the law's passage means that “premium payments in 2023 will hold mostly flat for Marketplace enrollees, since the premium tax credits shelter enrollees from increases in the underlying premium. The passage of the Inflation Reduction Act will extend temporary subsidies, preventing out-of-pocket premium payments from rising across the board next year for virtually all 13 million subsidized enrollees.”

The foundation added that “in the 33 states using, premium payments in 2022 would have been 53 percent higher (more than $700 per year more) on average if not for these enhanced subsidies.”

ACP is also pleased that the Biden administration has finalized a rule to help address the “family glitch” in determining eligibility for financial subsidies for insurance plans purchased through the ACA Marketplace. According to KFF, people whose workplace-funded coverage “is deemed unaffordable or of insufficient value” are eligible for financial assistance to buy insurance on the ACA Marketplaces; however, the affordability threshold of household income was based only on the cost of the employee's coverage and did not take into account the premium required to cover dependents. This “family glitch” affected coverage prospects for an estimated 5.1 million people — mostly children, according to KFF.

“ACP recommended that this change be made to ensure that families offered unaffordable family coverage through an employer could receive income-based premium subsidies to purchase ACA coverage,” Dr. Ryan D. Mire, president of ACP, said in a statement. “Closing this loophole will increase access to more affordable coverage and give families more coverage options.”

The American College of Physicians is ready to provide guidance to members who want to help their patients navigate the system during the current open enrollment period. Open enrollment for coverage via the federally run ACA Marketplace in 2023 began on Nov. 1. In most states, the deadline is Jan. 15, but National Public Radio reports that patients usually must sign up by Dec. 15 to get coverage that starts on the first day of the year.

Erickson cautioned members to be aware that the COVID-19 public health emergency may be lifted in January. If this happens, it could be the end of the pandemic-era continuous-enrollment of Medicaid-covered individuals. “There's an expectation that a number of people may fall off the Medicaid rolls across the country,” she said. “When the health emergency ends, members can help to make sure their Medicaid patients know how to re-enroll.”

ACP offers a guide for members to help their patients navigate the Medicaid landscape that is available on the ACP website. This webpage also includes links to other useful resources for ACP members about how to help patients obtain insurance coverage during the current ACA marketplace open enrollment window.

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