The U.S. Department of Health and Human Services (HHS), through the Office of the Secretary for Planning and Evaluation (ASPE), released a report showing new estimates for coverage related to the Affordable Care Act (ACA), concluding that the total enrollment for Medicaid expansion, Marketplace coverage, and the Basic Health Program in participating states has reached an all-time high of more than 35 million people as of early 2022.
The ASPE findings build on a report from the Centers for Medicare & Medicaid Services (CMS) showing a record-breaking 21 million people in more than 40 states and territories gained healthcare coverage thanks to the ACA’s expansion of Medicaid to low-income adults under 65. More than two million people gained coverage as a result of Medicaid expansion under the Biden-Harris Administration, ensuring healthcare coverage for underserved communities during the COVID-19 Public Health Emergency.
The ASPE report also describes new estimates from the National Health Interview Survey, showing that the uninsured rate in the fourth quarter of 2021 was at nearly an all-time low of 8.8% for the full population (similar to the 8.9% rate in the third quarter of 2021), compared to 10.3% in the fourth quarter of 2020.
The success of Medicaid expansion nationwide highlights a path to affordable, comprehensive, person-centered care for the 12 states (Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming) that have yet to expand their Medicaid programs. Additional state expansion would also be a key step to advance health equity: of the nearly four million uninsured Americans who could gain coverage if these states expanded their Medicaid programs, more than half are people of color. Oklahoma and Missouri, which expanded Medicaid coverage in 2021, saw an enrollment increase of more than 276,300 and 146,600 individuals, respectively.
The CMS report details key connections to coverage under the adult group created by the ACA for people with incomes up to 133% of the federal poverty level. In 2021, that translated to $17,130 for a single person and $35,245 for a family of four. Since the ACA became law in 2010, 38 states, the District of Columbia, and three U.S. territories have expanded Medicaid coverage to the adult group, resulting in more than 21 million people getting Medicaid coverage.
Medicaid expansion also closes essential coverage gaps for women, who make up more than half of the total adult group for Medicaid expansion. Efforts to extend Medicaid and CHIP coverage for pregnant and postpartum individuals to a full year after pregnancy are also important tools to address disparities.