Americans earning less than 150 percent of the federal poverty level — around $42,000 for a family of four — are eligible for free health plans that come with low deductibles and co-payments. Before the change, many such people could get free plans on the Obamacare marketplaces, but only with very high deductibles. This year, there were particularly large increases in sign-ups in Texas, Florida, Georgia and North Carolina — states with large low-income populations that have not expanded Medicaid, suggesting the new subsidies are driving the change.
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“It speaks to the power of free, but also free plans that are actually attractive,” said Cynthia Cox, who directs the Kaiser Family Foundation’s program on the Affordable Care Act. The foundation has been tracking the millions of low-income Americans who were eligible for coverage under the law but remained uninsured. Last year, that number fell substantially, and Ms. Cox said it would most likely fall again once new data on the uninsured rate is published.
Americans with incomes higher than four times the poverty level became eligible for subsidies for the first time as a result of the pandemic stimulus bill that Mr. Biden signed into law in 2021. Though this higher-earning group, often made up of the self-employed and early retirees, represented a relatively small share of the nation’s uninsured population, there is evidence that they represent a growing share of those covered by Obamacare plans.
The strong enrollment and improved political stability of the Affordable Care Act have helped make the marketplaces a more attractive place for insurance companies to do business. Several years ago, many insurers pulled out of the markets, but since Republicans tried and failed to repeal the Affordable Care Act in 2017, the plans have largely come back. More than 90 percent of people who signed up for this year had a choice among at least three insurance companies, according to the Centers for Medicare and Medicaid Services.
“That really has become an important and much more stable market,” said Matt Eyles, the president and chief executive of AHIP, the insurance industry’s largest trade group.
Last year, the Biden administration eliminated a longstanding barrier to subsidies for the family members of Americans who get insurance at work for themselves but not for their relatives. The change was estimated to affect more than five million Americans, a vast majority of whom were already insured through other means.
But while some of the enrollment in Affordable Care Act plans may reflect people shifting from other types of coverage, it appears that many of the new enrollees had no insurance before. The uninsured rate declined last year amid increased Obamacare enrollment, though a pandemic policy that requires extended Medicaid coverage by states probably also played a significant role.