Understanding the Surge in Affordable Care Act Marketplace Sign-Ups and What It Means for the Future
The Affordable Care Act (ACA) Marketplaces have witnessed an unprecedented surge in enrollment, reaching a record 24.3 million individuals in 2025. This figure more than doubles the enrollment numbers from 2020, marking a 113% increase over five years. This remarkable growth is largely attributed to enhanced premium subsidies introduced by the American Rescue Plan Act (ARPA) in 2021 and extended through 2025 by the Inflation Reduction Act (IRA).
States Leading the Enrollment Boom
While nearly all states experienced growth in Marketplace enrollment, certain states saw particularly dramatic increases. Notably, Texas (255%), Mississippi (242%), West Virginia (234%), Louisiana (234%), Georgia (227%), and Tennessee (221%) all saw their enrollments more than triple since 2020. Interestingly, 88% of the total growth since 2020 occurred in states that voted for President Trump in the 2024 election, with these states averaging a 157% increase in enrollment. In contrast, states that supported former Vice President Harris saw a 36% increase.
Factors Driving the Surge
Several key factors have contributed to this significant uptick in enrollment:
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Enhanced Premium Subsidies: The ARPA and IRA introduced and extended subsidies that made Marketplace coverage more affordable, attracting a broader range of enrollees.
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Medicaid Expansion Status: States that have not expanded Medicaid under the ACA witnessed higher Marketplace enrollment growth (188%) compared to expansion states (65%). This trend suggests that individuals in non-expansion states turned to the Marketplace for coverage options.
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Pre-Existing Uninsured Rates: States with uninsured rates of 10% or higher in 2019 experienced a 168% increase in enrollment, whereas states with lower uninsured rates saw a 50% growth. This indicates that areas with higher uninsured populations had more individuals seeking coverage through the Marketplace.
The Road Ahead: Policy Implications
The enhanced subsidies that have significantly boosted enrollment are set to expire at the end of 2025 unless Congress acts to extend them. Without these subsidies, enrollees could face substantial increases in premium costs, potentially leading to a decrease in coverage rates. Policymakers face critical decisions regarding the future of these subsidies and the overall structure of the ACA Marketplaces to maintain and further the gains achieved in recent years.*
How American Exchange Can Assist
Navigating the complexities of health insurance enrollment can be challenging. American Exchange offers expert guidance to individuals and organizations seeking to understand their options within the ACA Marketplace. Our team is dedicated to simplifying the enrollment process, ensuring that clients receive the maximum benefits available. To learn more and schedule a demo, visit below.
*All information sourced from KFF’s analysis on ACA Marketplace enrollment growth.
