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Enrollment numbers this year, last year, all years.

Tallying the Numbers: Enrollment from 2013-2017 

Since the Affordable Care Act opened up federal and state marketplaces in 2013, over 20 million people have gained health insurance through public and private options. To some, the success of a government program hinges on how many people – specifically, the people to whom the program is targeted – participate. In order to keep costs down, insurance companies have been counting on young, healthy individuals to purchase private health insurance. A larger pool of healthy applicants keeps premiums low for everyone, including the people who need more care, like older adults or those with pre-existing conditions.

When premiums spiked for 2017, critics of the ACA immediately pointed to a lack of participation as the reason for rising costs. It’s true that insurers have been hesitant to participate in the marketplaces this year, and that not enough of the preferred demographic has signed up in the three years since the health insurance exchanges opened. But despite rising costs, American consumers have flooded the public and private marketplaces this year in record numbers, indicating that access to affordable health insurance remains an important issue.

Enrollment Numbers for 2017

Open enrollment ended on January 31 for 2017 coverage, but the data that has been collected up to the middle of this month gives us a good picture of what to expect. As of December 24, 2016, 11.5 million people had used the federal marketplace to buy health insurance. Of that number, 8.9 million people renewed their coverage or bought new plans to replace existing plans, and 2.6 million were brand new to the marketplace.

Approximately 81 percent of the people who signed up for insurance through the marketplace are going to use tax credits to help offset the costs of health insurance. That means about 9.3 million people are going to have to find a new way to pay for healthcare if President Trump takes away the tax credits, as he said he would during his campaign.

ACA Numbers for 2016

Comparing total enrollment for last year isn’t as straightforward since the signup period just ended, but it’s clear that more people will have signed up for coverage this year compared with 2016. The number of people who signed up for health insurance during open enrollment last year topped 12.7 million people. In 2016, about 9.6 million people got their coverage from the federal marketplace, and 4 million of those subscribers were first-time insurance buyers.

As way of comparing 2016 to 2017, the number of people who had purchased insurance through the marketplace up to December 24, 2015 was 286,000 people shy of the 2016 number for the same period. At that pace, it’s expected that the 2017 numbers will either match or eclipse the 2016 numbers by the time 2017 enrollment ends nationwide.

From November 1, 2015 to February 1, 2016, just over 29.4 million people used Healthcare.gov, and another 1.7 million people used the Spanish equivalent website, CuidadoDeSalud.gov. Enrollment for 2016 was the third signup period since the marketplaces opened, and many of the improvements that had been implemented over the previous two years helped to accommodate a higher volume of callers.

What About Medicaid?

Medicaid has played a large role in the success of the Affordable Care Act, if for no other reason than that the program has been expanded in many states. When you hear that 20 million people could lose coverage if Obamacare gets repealed, the bulk of that figure comes from Medicaid enrollment. The ACA provided for several features to expand and bolster the program so that more low-income families, particularly those whose incomes exceeded traditional guidelines, could access government-sponsored health insurance.

Not every state expanded the Medicaid program, partially due to politics and partially due to the lengthy list of federal regulations that had to be adhered to. For states that did expand, millions of additional Americans gained access to health insurance, and some states saw almost immediate benefits for their residents.

From September 2013 to November 2016, the ACA was responsible for an increase of over 18 million Medicaid enrollments across most of the states. These are low-income families who previously did not qualify for Medicaid because they made too much income to satisfy state income requirements. Thanks to the increase in Medicaid funding through the ACA, these individuals and families were finally able to get health coverage.

This number represents a 30 percent increase in the number of people who could rely on Medicaid on either a long or short-term basis to offer the health coverage they needed. If the ACA’s Medicaid provisions are removed and replaced with federal block-grant funding, then the future of the program is up in the air for millions of people across the country.

Total ACA Signups Since the Start

Marketplace statistics for the ACA do not include Medicaid or Medicare plans. From September 2013 through February 2015, the ACA saw a net signup of 16.9 million people. We can get an idea as to how many people have signed up for the ACA in total by adding the first two years of the program in with the number of new subscribers in 2016 and 2017. When you crunch the numbers, you get a total of around 23.5 million people.

If you add in the number of new Medicaid enrollees, about 41.5 million Americans have gotten health insurance since the Obamacare marketplaces opened in 2013. For the private market, the Affordable Care Act has been a significant achievement in numbers alone. Some of Trump’s voters are now worrying about losing access to health insurance themselves, despite the clarity of Trump’s position on healthcare throughout his campaign. He was not mysterious about his plans for Obamacare.
Health coverage in the United States has been a hot topic for decades, particularly for the last three election cycles. How the system may change under President Trump is anyone’s guess at this point, but enrollment numbers point to the continued demand for affordable coverage.