How Many People Were Insured by the ACA?

The Affordable Care Act (ACA), often called Obamacare, significantly expanded health insurance coverage in the United States since it was enacted in 2010. The ACA expanded Medicaid eligibility, provided subsidies for private insurance plans, and prohibited exclusions for preexisting conditions. As a result, millions of previously uninsured Americans gained health coverage. So exactly how many people now have insurance under the ACA?

ACA Health Coverage Provisions

The main provisions of the ACA that expanded insurance coverage include:

• Medicaid Expansion – States could expand Medicaid eligibility to adults under 65 with incomes up to 138% of the federal poverty level.

• Marketplace Subsidies – Provides income-based subsidies for individuals to purchase private health plans on ACA marketplaces.

• Preexisting Conditions – Required insurers to offer coverage to anyone regardless of health status.

• Dependent Coverage – Allowed young adults up to age 26 to remain on a parent’s health plan.

• Individual Mandate – Required all Americans to have qualified health coverage or pay a tax penalty. This was eliminated in 2019.

Current Enrollment in ACA Programs

According to the U.S. Department of Health and Human Services (HHS), over 35 million Americans had health coverage through the ACA as of early 2022. Here is the breakdown by coverage provision:

• Medicaid Expansion: Over 21 million enrolled
• Marketplace Plans: Over 14 million enrolled
• Basic Health Plans: Over 1 million enrolled

These enrollment figures represent the highest totals ever for the ACA since its implementation. The numbers include nearly 2 million Americans who newly gained Medicaid expansion coverage during the COVID-19 pandemic.

Medicaid Expansion Enrollment

The Medicaid expansion provision of the ACA allowed states to extend Medicaid eligibility to adults under 65 who earn up to 138% of the federal poverty level.

As of 2021, 38 states plus Washington D.C. have adopted Medicaid expansion. The states that have not expanded Medicaid are:

• Alabama
• Florida
• Georgia
• Kansas
• Mississippi
• North Carolina
• South Carolina
• South Dakota
• Tennessee
• Texas
• Wisconsin
• Wyoming

Among states that did expand Medicaid, enrollment has grown steadily:

• 2015: 9.6 million enrolled
• 2018: 12 million enrolled
• 2021: 21 million enrolled

This indicates broad utilization of Medicaid expansion coverage in participating states. If the 12 remaining states expanded Medicaid, an estimated 4 million more Americans could gain insurance.

Marketplace Plan Enrollment

The ACA Marketplace offers private individual health plans to Americans who don’t qualify for Medicaid but still need coverage. Income-based subsidies help make premiums affordable.

Enrollment in marketplace plans grew rapidly in the initial years of the ACA but then declined from 2016 to 2020. However, there was a major enrollment rebound in 2021 and 2022:

• 2014: 8 million enrolled
• 2016: 12 million enrolled
• 2020: 11 million enrolled
• 2022: 14 million enrolled

The COVID-19 pandemic led to increased enrollment as more Americans sought health coverage. Higher subsidies from the American Rescue Plan also enhanced affordability.

Pre-ACA Compared to Now

Prior to the ACA, the uninsured rate for non-elderly adults was over 16% in 2010. After the initial ACA open enrollment period in early 2014, that uninsured rate dropped to around 11%.

By the end of 2021, after a surge in Medicaid and marketplace enrollments during COVID-19, the uninsured rate reached an all-time low of 8.9%. This indicates the ACA’s significant impact on covering millions more Americans.

Key Takeaways

• Over 35 million Americans had health coverage through the ACA’s Medicaid expansion, marketplaces, and other provisions as of early 2022.

• Medicaid expansion resulted in over 21 million people gaining coverage in participating states.

• Fourteen million Americans enrolled in private health plans on the ACA marketplaces.

• The U.S. uninsured rate reached record lows following increased enrollment during COVID-19.

• Millions more Americans, especially in states that haven’t expanded Medicaid, still lack ACA coverage.