About 24.2 million people signed up for Affordable Care Act plans during the open enrollment period for 2025, with huge increases in major Republican-led states.
Jan. 21, 2025 - Healthcare Dive
Rebecca Pifer, Senior Reporter
About 24.2 million people signed up for Affordable Care Act plans during the open enrollment period for 2025 ・an all-time high, blowing past last year’s previous record of 21.3 million.
The enrollment figures were announced by the Biden administration on Friday, three days before President Donald Trump was sworn into office, ushering in a Washington notably less friendly to the ACA. The Trump administration is expected to chip away at the 15-year-old law, including by introducing alternative plans and reducing funding for programs that help people navigate the exchanges.
Still, much of the enrollment growth was in Republican states, including Florida, Texas and Georgia, which makes it more difficult for Trump to take drastic action targeting the ACA without angering conservative voters, according to experts.
Enrollment for 2025 got off to a slow start at the beginning of the open sign-up period in the fall. Some Americans who put off insurance elections said they were concerned how the Trump administration might affect their coverage. However, the pace of sign-ups picked up before enrollment concluded last month ・and most people with existing ACA coverage were automatically reenrolled in plans, according to regulators.
2025 ACA enrollment and change from prior year by U.S. state
Experts are split on whether Trump will preserve more generous tax cuts that are credited for swelling ACA enrollment by millions of people since the coronavirus pandemic. Absent congressional action, the subsidies are set to expire by the end of this year.
Republicans are on the hunt for spending cuts to pay for the president’s promised tax breaks, making it unlikely the subsidies survive this year in their current form. However, because of the razor-thin Republican majority in Congress and political popularity of the ACA, some experts think the subsidies will be extended｜ut shrunk so that fewer people are eligible.
Top healthcare regulators in the Biden administration called on Congress to preserve the subsidies on their way out the door.
“Congress must do its job so those millions of Americans remain covered,” Xavier Becerra, Biden’s HHS Secretary,《aid in a statement Friday.
The future of the subsides isn’t expected to be resolved until the back half of the year, creating uncertainty for insurers offering plans in the exchanges. But in the meantime, continued enrollment growth is a boon for insurers like marketplace giant Centene, which has chalked up much of its recent revenue and earnings growth to the ACA marketplaces.
High enrollment in ACA plans is also positive for hospitals, doctor’s offices and other providers, as it lowers the risk of uncompensated care.