Dive Brief:

• Roughly 14.5 million Americans signed up for health insurance through the Affordable Care Act exchanges for 2022, a 21% increase over last year and the highest volume since the law was signed 12 years ago, the Biden administration said on Wednesday.
• Roughly 10.3 million people enrolled from the 33 states that use the online Healthcare.Gov marketplace funded by the federal government. Another 4.3 million enrolled in states that sell the subsidized insurance directly to their residents.
• One big reason so many people enrolled is that the Democrat-led Congress provided additional subsidies and elongated the window to sign up for the coverage via the $1.9 trillion American Rescue Plan signed last year. However, those subsidies are temporary and set to expire at the end of this year.

Dive Insight:

The ACA has helped improve healthcare for millions of Americans, including historically underserved populations, President Joe Biden said in a statement on Wednesday. Health equity is a key prong of his administration's health policy agenda, and the government-backed insurance, that provides subsidies to those who qualify, saw in a 35% increase in enrollment for Black Americans, and a 26% increase in enrollment for Hispanic Americans, Biden said.

During the first full year of the Biden administration, almost 6 million new consumers signed up for coverage through marketplaces nationwide during the 2021 special enrollment period, and the 2022 open enrollment period that ended mid-January, according to HHS.

The government has thrown open the doors to ACA coverage during the pandemic, notably through enhanced premium assistance provided under the ARP COVID-19 relief package. Nationwide, 2.8 million more consumers are receiving tax credits in 2022 compared to the year prior, HHS said.

Biden has pushed to make the subsidies permanent, though that appears unlikely as his Build Back Better bill has stalled in Congress. According to a new report from the Assistant Secretary for Planning and Evaluation released Wednesday, an estimated 3.4 million Americans currently insured in the individual market will lose coverage if the ARP's premium tax credits aren't extended beyond this year.

In addition to the subsidies, the ARP also allows low-income Americans to sign up outside of the traditional enrollment season, resulting in CMS recently launching a new special enrollment period. Americans with incomes under 150% of the federal poverty level that did not sign up for ACA coverage for this year can now enroll in plans with $0 premiums through the federal exchange.

The ACA was signed into law in 2010, when Biden was vice president for former President Barack Obama. The sweeping health legislation has survived numerous efforts from Republicans in Congress to repeal it, along with dogged efforts from the Trump administration to chip away at its protections.

"The ACA turns 12 with record enrollment due to Biden Administration actions to reinvigorate the law, plus no meaningful political or legal threats to its existence for the first time since its passage," the Kaiser Family Foundation's Larry Levitt commented.

More than 18.7 million adult Americans across 39 states also now have coverage due to the ACA's Medicaid expansion, Biden said on Wednesday, though 12 states have yet to expand Medicaid to a greater portion of their low-income residents.

The safety-net Medicaid program has grown to record size as the pandemic's economic upheaval pushed millions of Americans off job-based insurance.

However, experts say those gains could be rolled back if states resume eligibility determinations in droves once the COVID-19 public health emergency expires.