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Affordable Care Act

ACA Marketplace 2021 Enrollment Rise in Nonexpansion States – No Cure

UI effect? ACA marketplace enrollment soared at low incomes in nonexpansion states in 2021, XPOSTFACTOID, May 3, 2021, By Andrew Sprung

I don’t think it’s an exaggeration to say that enrollment [in ACA marketplace plans] at the lowest subsidy-eligible income levels in nonexpansion states exploded this year. 

Enrollment at 100-150% FPL in these fourteen states increased by 16.7% over 2020. For comparison, total marketplace enrollment in all states at all income levels was up 5.2% this year. The total increase in this income bracket in these fourteen states, 424,957, is 71% of the entire increase nationwide, 594,918. 

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Comment by Isabel Ostrer

Over one million Americans have newly enrolled in Affordable Care Act marketplace plans this year. This was facilitated by President Biden expanding the enrollment period as a response to Covid-19 pandemic-caused mass unemployment and ongoing health fears for many Americans. Many millions remain uninsured.

Indeed, the pandemic has exposed the rickety scaffolding on which U.S. health insurance is constructed. Over half of Americans receive insurance through their jobs. But the rest of adults under age 65 — working or not — face a conundrum. They must either be poor enough to qualify for Medicaid (a near impossibility in certain states — like Texas, where an adult must earn <14% of the federal poverty line (FPL) to qualify for Medicaid) or earn enough to qualify for subsidized coverage through the ACA marketplace (in nonexpansion states subsidies start at 100% FPL). 

What happens to Americans who fall through the scaffolding? There is huge pent-up demand for health insurance in this group. With recently increased unemployment income (also pandemic-era legislation), many adults in nonexpansion states have been nudged into an income tier where they qualify for subsidized marketplace plans. As health policy expert Sprung points out in his post, every nonexpansion state except Wisconsin has seen a surge in enrollment among adults who earn 100-150% FPL. 

Despite these coverage gains, tens of millions of Americans remain ineligible for health insurance. Instead of propping up our piecemeal insurance system and padding the pockets of private corporations in the process, the obvious solution is a shift to unified single payer insurance. All Americans deserve access to affordable, comprehensive health insurance. Single payer is the answer.

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