More Than 20 Million People Have Signed Up for Obamacare Plans, Blowing by Record

More than 20 million people have signed up for plans on the Affordable Care Act’s marketplaces during the annual open enrollment period, far surpassing last year’s record of more than 16 million enrollments, the Biden administration announced on Wednesday.

The figures were a landmark moment for the 2010 health law, underscoring the significance of enhanced subsidies for Americans and the continuing reach of the marketplaces after years of Republican efforts to whittle them down.

“The marketplaces are getting stronger and more embedded into the fabric of U.S. health care,” said Adrianna McIntyre, a health policy expert at the Harvard T.H. Chan School of Public Health. “The more the marketplaces grow, the more it enhances their stability.”

The Biden administration revealed last month that on Dec. 15 — the deadline to sign up for coverage that began on Jan. 1 — almost 750,000 people signed up for a marketplace plan on HealthCare.gov, the largest single-day total. The full tally could grow in the coming days; the deadline to sign up for plans is 5 a.m. Eastern on Jan. 17, giving Americans coverage that begins next month.

“The Affordable Care Act is more popular than ever,” President Biden said in a statement.

The enrollees include people like Kennita Hickman, 39, who has several autoimmune disorders and was on the verge of losing her Medicaid coverage late last year because her income was too high to qualify for the government program. She found a lifeline in a free Obamacare plan, which has allowed her access to doctors and a therapist.

“I have three health conditions that I have to manage,” said Ms. Hickman, who owns a media company in Milwaukee. “Being without insurance is always scary.”

Health policy experts say the record number of sign-ups has been largely attributable to increased federal subsidies for those purchasing plans on the marketplaces, which were initially part of a congressional spending package in 2021. The subsidies, which increased at every level of income, were renewed through 2025.

Researchers have estimated that in the roughly 30 states using HealthCare.gov, premium payments would have been more than 50 percent higher on average if not for the subsidies.

The subsidies have proved helpful to broad swaths of Americans, including those in upper-middle-income groups. And they have allowed many lower-income Americans, including Ms. Hickman, to sign up for plans with no premiums and lower deductibles.

Some of those signing up on the marketplaces lost Medicaid for the first time since the onset of the coronavirus pandemic, after a federal rule guaranteeing coverage expired in April and forced millions of people to hunt for new plans.

In his statement on Wednesday, Mr. Biden called out “extreme Republicans” for efforts to block reforms.

“Their plan would raise costs for millions of people, especially older Americans and small business owners who rely on the marketplace for their coverage, by repealing the improvements I signed into law,” he said. “In fact, they want to repeal the Affordable Care Act, just as my predecessor tried and failed to do.”

The political context was clear. Former President Donald J. Trump, the front-runner for the Republican presidential nomination, has threatened an overhaul of the Affordable Care Act in recent weeks, recalling the early months of his presidency, when he cheered on a failed Republican-led effort to dismantle the law. Mr. Biden’s campaign quickly amplified Mr. Trump’s comments.

Mr. Trump might not have the party backing to replace the health law, even if he were to win the White House with full Republican control of Congress. After his threat, some Republican lawmakers have suggested changing the marketplaces to improve the quality and affordability of plans, while others have conceded there is most likely little appetite for a broader repeal.

About six in 10 adults approve of the health law, part of a steady increase in popularity since the same time in 2016, when only around four in 10 approved, according to polling released in May by KFF, a nonprofit health policy research group.

The plans were once further out of reach for middle-class Americans. People qualified for subsidies on a sliding scale based on income, with the remaining premiums sometimes prohibitively expensive.

Critics of the health law have argued that even with enhanced federal subsidies, plans can be expensive. Coverage with lower premiums often carry high deductibles and co-payments.

The record number reported on Wednesday can be partly explained by the increasing size and sophistication of networks that help Americans choose new or different plans. The Biden administration has spent hundreds of millions of dollars fortifying those so-called navigator groups and the marketing campaigns that publicize the marketplaces.

The federal government funneled nearly $100 million into navigator organizations that helped increased enrollment this winter. One of those groups is Covering Wisconsin, which assisted Ms. Hickman in her search for a plan last month.

“We have had more appointments than ever,” said Adam VanSpankeren, the group’s navigator program manager. “We’ve had our schedules fill up. Going into November, I had navigators with schedules booked Thanksgiving and beyond.”

Covering Wisconsin, which has more than 40 navigators across the state, has seen an 82 percent increase in marketplace enrollments compared with last year, Mr. VanSpankeren added.

Rawha Abouarabi, who oversees a federally funded navigator team in Michigan at the Arab Community Center for Economic and Social Services, said many of those signing up were like Ms. Hickman, with incomes just above the limit for Medicaid but without the option to sign up for employer-sponsored insurance.

Ms. Abouarabi said her group had enrolled more than 600 new people in plans since November, while about the same number had re-enrolled in the marketplace. A vast majority of those already enrolled in marketplace plans through her organization had returned this winter to re-enroll. That was a sign of the attractiveness of plans, she said.

More insurance companies have joined the market in recent years, noting the demand for coverage and the variety that Americans have sought in choosing plans.

“That can create a problem of choice overload,” said Dr. McIntyre, the health policy expert at Harvard. But as more people enroll with those insurers, she added, “it makes the markets larger and harder to disrupt.”