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2024 will see record signups for ACA health insurance plans


The Affordable Care Act's health insurance marketplace will hit a record high for sign-ups this year, topping last year's record high. That's according to an analysis from the Kaiser Family Foundation. Cynthia Cox is a Family Foundation vice president and director of the program on the ACA. She joins us now from Washington, D.C. Thanks so much for being with us.

CYNTHIA COX: Hi. Thanks so much for having me.

SIMON: Let's begin with the numbers. What makes this a record year on the ACA exchanges?

COX: Yeah, so just in the last few years, the ACA marketplaces have almost doubled in size. So in 2020, there were about 11 million people signed up for ACA marketplace coverage. Now we're at over 20 million people for 2024. And the open enrollment period still has a few more days left, so I wouldn't be surprised if that number gets even higher.

SIMON: And what do you think is driving all the sign-ups?

COX: The Affordable Care Act always had subsidies to make health insurance more affordable for people who were buying their own insurance on these marketplaces. But in the wake of the pandemic, and then also with the passage of the Inflation Reduction Act, there were even more generous subsidies on the market. And I think more and more people are finding out about this additional help. And, you know, there's also - you know, people still had Medicaid coverage during the pandemic who may not technically be eligible for it anymore. Fourteen million people have been disenrolled from Medicaid since April of last year.

Now, some of those people are going to get Medicaid again. Some of them are going to get coverage through work. But for those who cannot get coverage through work or Medicaid, then that's exactly why the ACA marketplace exists. It's a place for people to go who can't get coverage through other means. And so the subsidies are available for people. And, you know, especially if you're low income and you're transitioning off of Medicaid, then chances are you could probably get free or very low-cost private insurance through the ACA marketplace.

SIMON: Is the coverage that people are receiving the kind of insurance, quality insurance, President Obama promised?

COX: So for some people, they can get - like, especially if you're really low-income, you can get insurance on the ACA marketplaces probably for free, either - maybe $0 a month, 1 or $2 a month for a premium. And your deductible could be very low. It could be less than $100 a year. If you're middle income, there's a sliding scale. So then for more middle-income people, they might have to pay a few hundred dollars a month for health insurance coverage. They might have a deductible of a few thousand dollars. So it really, I think, is going to depend on the person, but I think overall what we're seeing is that many, many more people are finding this to be a good value for them than had been the case a few years ago.

SIMON: President Trump, of course, has repeated his vow to repeal and replace the Affordable Care Act. Do these numbers suggest that the law is now so well established it would be difficult to repeal?

COX: The Affordable Care Act that President Trump and Republicans in Congress in 2017 were trying to repeal - I think it was a different situation, almost a different law. At the time, you know, the marketplaces were really struggling. There was wall-to-wall news coverage about insurance companies leaving the market, saying there was no way to be profitable in this market. There were even concerns that some parts of the country might not have any health insurers offering, which would basically make the market implode in those parts of the country. There was a lot of difficulty in the early rollout of the ACA, but what we've seen since then is that the markets have not just stabilized, but they've become profitable for insurers. We're seeing more and more companies entering into the market. We're seeing more and more people sign up for this coverage. So I think it's just, you know, such a different situation than it was a few years ago when we were talking about repeal and replace then.

SIMON: Are there fixes that you would like nevertheless to see made?

COX: Well, you know, I don't make policy recommendations. We're a nonpartisan organization. But one of the things that the Affordable Care Act did was make this coverage more affordable for individuals through subsidies. But the raw premiums are still really expensive, so that means taxpayers are paying a lot of money to cover those costs. And so there's probably more that can be done to address the underlying reasons why health insurance is so expensive in the United States. And, you know, there's also challenges that we have seen with our surveying of people who are signing up on this market. Sometimes they have a difficult time navigating the sign-up process and also a difficult time actually using their health care. You know, there certainly is still room for improvement, but overall, I would say that the marketplaces are in a much more stable and solid situation than they were several years ago.

SIMON: Cynthia Cox of the Kaiser Family Foundation, thanks so much.

COX: Thank you so much for having me. Transcript provided by NPR, Copyright NPR.

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Scott Simon is one of America's most admired writers and broadcasters. He is the host of Weekend Edition Saturday and is one of the hosts of NPR's morning news podcast Up First. He has reported from all fifty states, five continents, and ten wars, from El Salvador to Sarajevo to Afghanistan and Iraq. His books have chronicled character and characters, in war and peace, sports and art, tragedy and comedy.