Almost 50 million Americans have had health insurance provided through the Affordable Care Act at some point over the past ten years, the White House announced Tuesday. Since 2014, one in seven Americans has taken advantage of the program that was enacted in 2010, allowing people to buy affordable health insurance that wasn’t available to them through their work or government-subsidized programs such as Medicare and Medicaid.

What You Need To Know

  • Almost 50 million Americans have had health insurance provided through the Affordable Care Act at some point over the past ten years, the White House announced Tuesday

  • The Affordable Care Act was enacted in 2010, allowing people to buy affordable health insurance that wasn’t available to them through their work or government-subsidized programs such as Medicare and Medicaid

  • In February 2024, the ACA logged its highest enrollment ever — 20.8 million

  • While ACA enrollment was highest in 2014, when the ACA’s health insurance marketplaces rolled out to all of the states, a new report from the U.S. Treasury Department’s Office of Tax Analysis found that ACA enrollment rose after the COVID pandemic began

“Today, the ACA marketplace is part of the fabric of the American healthcare system, and it is a crucial reason we have historic levels of insurance coverage in our country,” White House domestic policy adviser Neera Tanden said in a briefing about the milestone.

In February 2024, the ACA logged its highest enrollment ever — 20.8 million. In 2023, 16.2 million people had an active ACA policy.

While ACA enrollment was highest in 2014, when the ACA’s health insurance marketplaces rolled out to all of the states, a new report from the U.S. Treasury Department’s Office of Tax Analysis found that ACA enrollment rose after the COVID pandemic began. It increased more dramatically following the American Rescue Plan Act in 2021, which expanded tax credits for program enrollees, and again after passage of the Inflation Reduction Act in 2022, which extended those credits.

Tanden said the cost of ACA coverage has fallen $800 per person per year during the Biden-Harris administration.

For its analysis, the Treasury Department compared ACA enrollment data from the Department of Health and Human Services with Internal Revenue Service data to see how many individuals had ever claimed coverage on their tax returns, even if only for a few months between jobs. In total, it found 49.4 million Americans, or 14% of the population, has had ACA coverage at some point over the last decade.

“Before the ACA was enacted in 2009, Treasury researchers published an analysis that looked at health coverage over time and predicted that the number of Americans who would benefit from the ACA’s insurance options over a decade would be much higher than the number who would benefit at any one point in time,” Treasury’s acting assistant secretary for tax policy Aviva Aron-Dine sad. “As it turns out, that’s exactly what we’ve now found.”

Aron-Dine said health insurance marketplace usage is higher in states that did not adopt the ACA Medicaid expansion that's been available since 2014 or that only adopted it recently. In Florida, Utah and Georgia, at least 20% of the population have used ACA health insurance marketplace insurance. 

She said the new data is “another piece of evidence that the ACA marketplaces are working, contributing to health and economic security and in particular letting people purchase comprehensive affordable health insurance when they experience short- or longer-term gaps in access to other coverage.”