On More Generous Terms, Obamacare Proves Newly Popular

A record number of Americans — 13.6 million — have signed up for health plans through the Affordable Care Act’s marketplaces for 2022, after Congress lowered the cost of Obamacare insurance; the Biden administration boosted advertising; and the pandemic disrupted many Americans’ employer-provided coverage.

The Covid-19 public health emergency helped usher in an era of greater generosity and expanded outreach to the uninsured that many of Obamacare’s original authors had long called for.

The increased enrollment, covering at least two million more Americans than in any previous year, was particularly pronounced in states like Georgia and Texas that have high rates of uninsurance and declined to expand Medicaid to cover their poorest adults.

“What a great day it is to really see how the programs are working as they are intended,” Chiquita Brooks-LaSure, the administrator for the Centers for Medicare and Medicaid Services, which manages the marketplaces, told reporters on a conference call.

The Biden administration has invested heavily in promoting the availability of insurance subsidies under the Affordable Care Act. It also quadrupled the network of professionals available to help people enroll. But Ms. Brooks-LaSure said she thought the main driver of the enrollment increase was the lower prices most Americans would pay.

A stimulus bill passed by Congress in March made many more Americans eligible for financial assistance in buying Obamacare plans. For most people with low incomes, comprehensive coverage is currently available for no premium. Middle-class people earning higher incomes became eligible for subsidies for the first time.

Taken together, the policies have represented an expansion and a reimagining of the Affordable Care Act, what some policy experts have called Obamacare 2.0. The enrollment numbers suggest that these changes have substantially increased enrollment in the program, counteracting coverage declines from falling employment during the pandemic.

But those gains may be fragile. The enhanced subsidies are scheduled to expire at the end of 2022. Democrats in Congress hope to extend them through 2025 as part of their large social spending and climate bill, but that legislation is currently stalled in the Senate.

“The only cloud on the horizon is the current uncertainty with the Build Back Better Act now being in limbo,” said Peter Lee, the executive director of California’s marketplace, Covered California. “Because if the subsidies that are expanded under the American Rescue Plan aren’t continued, the sad truth is hundreds of thousands of Californians will drop coverage after next year, and millions of Americans will drop coverage across the country.”

Federal health officials said enrollment gains were most pronounced in states that had not expanded their Medicaid programs. Enrollment in Georgia grew by a third from last year, and enrollment in Texas increased by more than a quarter. The Build Back Better package would also create new insurance options for poorer residents of those states.

Laura Colbert, the executive director of Georgians for a Healthy Future, a consumer advocacy group that also helps sign…