Affordable Care Act Enrollment

Data Journalist

Updated on June 16th, 2021

Reviewed by Charles Gaba

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Affordable Care Act Enrollment Edges Up in 2021

With the goal of providing near-universal coverage to Americans, the Affordable Care Act’s health insurance marketplaces launched in the fall of 2013, offering plans for the calendar year 2014. 

Growing from just over eight million in the first plan year 2014 to almost 12.7 million in 2016, enrollment in plans offered on the federal and state marketplaces then began to drop off. Many experts point to affordability as the cause for the losses, with surveys conducted at the time among Americans who visited marketplace websites but didn’t enroll showing that more than half of them cited cost as the reason.1

Experts also cite actions taken by the Trump administration as reasons for enrollment losses between 2016 and 2020. These include eliminating the individual mandate, cutting subsidies in the marketplace, shortening enrollment periods, slashing funding for outreach, and ending federal standards for benefits and cost-sharing.2 

However, recent snapshots from the 2021 enrollment period show that overall plan selection totals on the federal Health Insurance Marketplace rebounded significantly from 2020. The Centers for Medicare & Medicaid Services’ (CMS) January 12 final weekly snapshot shows enrollment on the federal platform up by 7.0% from 2020.3 This indicates that, after including enrollment on state exchanges, figures will have increased nationwide. The rise in enrollment was the first of the Trump administration.

CMS cites lower premiums, more plan options, an increase in the number of licensed agents, and an improved experience as reasons for the improved enrollment.4

Another major factor was a spike in mid-year 2020 Special Enrollment Period (SEP) enrollments due to the COVID-19 pandemic; at least 450,000 people nationally who normally wouldn’t have enrolled did so via SEPs due to losing their existing job-based coverage or for other pandemic-related reasons. Most of those SEP enrollees renewed their coverage into 2021.5

Enrollment got a further boost from a package of healthcare executive orders signed by President Joe Biden. Among other initiatives, the package responded to COVID-19 by reopening on February 15, 2021 for a special six-month enrollment period that has topped one-million people.

Experts point to the importance of the marketplaces during the pandemic. They note that renewals were up by 13.2% from 2020, showing the demand for comprehensive coverage.6 However, enrollment of new customers dropped 3.6%, evidence that the marketplaces face continued difficulty in attracting the young customers required to ensure the stability of the overall risk pool.   

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  1. Collins, Sara, Munira Gunja, Michelle Doty, and Sophie Beutel. “To Enroll or Not to Enroll? Why Many Americans Have Gained Insurance Under the Affordable Care Act While Others Have Not.” | Commonwealth Fund, September 25, 2015. 

  2. Sabotage Watch: Tracking Efforts to Undermine the ACA.” Center on Budget and Policy Priorities, January 20, 2017.

  3. “Press Release CMS Releases Final Snapshot for the 2021 Federal Exchange Open Enrollment Period.” CMS, January 12, 2021.

  4. Ibid

  5. Keith, Katie. “ Enrollment Rises; More Enrollment Data: Health Affairs Blog.” Health Affairs, December 21, 2020.

  6.  Keith, Katie. “ Enrollment Rises; More Enrollment Data: Health Affairs Blog.” Health Affairs, December 21, 2020.