Obamacare enrollment is surging. Here’s where.

Jan 17, 2024

Presented by the Coalition to Protect America's Health Care

With Megan R. Wilson

Driving the Day

OBAMACARE TAKES OFF — Many Southern states are seeing Affordable Care Act enrollment surge as the number of people covered under such plans hits new highs.

Last year, more than 20 million people signed up for year 2024 plans — a new high. The previous record was 16.3 million sign-ups for the 2023 plan year. Open enrollment ended Tuesday in most states.

So far, states in the South and the Rust Belt have had among the highest rates of enrollment growth between 2023 and 2024 plan years, according to a POLITICO analysis of HHS data.

Louisiana and West Virginia have the highest growth rates — about 63 percent each. Only a handful of states saw slight dips, but that doesn’t include weeks of data that hasn’t yet been released.

Obamacare enrollment surges in the south

Alabama, Arkansas, Georgia, Indiana, Mississippi, Ohio, South Carolina, Tennessee and Texas all had growth rates between 36 and 52 percent.

The enrollment increase comes as former President Donald Trump has renewed calls to replace the ACA on the campaign trail.

“It’s become less of a hot-button issue over the last few years,” said Mina Schultz, health policy and advocacy manager at advocacy group Young Invincibles.

Here are some factors that might be driving the growth:

Medicaid unwinding: The surge comes as more than 15 million people have lost Medicaid coverage since pandemic requirements that states keep people on rolls to get enhanced funding expired.

“A large percentage” of those enrolling this year have come off Medicaid, Jeremy Smith, program director for the West Virginia Navigator program, told Pulse.

Enrollment navigators: The Biden administration has invested substantially in enrollment navigators to aid those looking for a plan — about $100 million. That’s about 10 times what the Trump administration had allotted in the 2018 open-enrollment period.

“The ones in the Rust Belt and the Southern states pop out to me as having really good, experienced navigator and assister programs,” Schultz said.

The funding has facilitated more expansion, advertising and travel, Smith said.

“It’s allowed us to be out on the ground all the time.”

Subsidies: Subsidies enacted under the Biden administration have cut premium costs.

“A few years ago, people would look at the marketplace here and [be] interested but not always completely sold,” Smith said. “[The enhanced subsidies] have made a huge difference.”

United Way of Metropolitan Dallas enrolls at least 3 in 5 people in a plan with monthly premiums of $10 or less, said Daniel Bouton, vice president of health and wellness at the group.

More to come? People booted from Medicaid have a special enrollment period through the end of July for ACA plans that could boost enrollment later in the year.

WELCOME TO WEDNESDAY PULSE. Del. Eleanor Holmes Norton (D-D.C.) reminds us that sledding is allowed on the Capitol grounds. Send us your sledding tips and funding deal gossip. Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.

Listen to today’s Pulse Check podcast

A message from the Coalition to Protect America's Health Care:

If Congress Cuts Hospital Care, Patients Will Pay. https://actnow.protecthealthcare.org/a/no-cuts-to-care

In Congress

Doctor Judah Eastwell a GP at St Johns Medical Centre, consults a patient via a video link to their home

Health savings account reforms, such as allowing certain plans to cover telehealth before deductions, didn't make it into Congress' long-awaited tax package. | Christopher Furlong/Getty Images

HSA REFORM MISSES RIDE, FOR NOW — Efforts to reform tax-free health savings accounts tied to high-deductible health plans missed one of their best chances to move this year: It was left out of a bipartisan, bicameral tax package unveiled Tuesday.

Congress’ top tax writers’ proposal would boost subsidies for affordable housing and temporarily expand the Child Tax Credit, but health policy was absent. The House Ways and Means Committee had advanced legislation that would enable plans to cover telehealth and chronic care services pre-deductible, include the direct primary care payment model and offer on-site health clinics, as well as bolster the amount of money people can contribute.

The bills had moved through markups but ran into substantial opposition from Democrats, who charged that the plans are higher risk for lower-income people and the bills could benefit the well-to-do.

More than 60 million people are enrolled in high-deductible plans, which have low premiums and tax benefits but make patients pay more before benefits begin.

The path forward: It’s unclear which provisions GOP lawmakers might convince Democrats to support. But the exclusion isn’t a death knell for HSA reform this Congress, with potential vehicles in a March spending deal or during the lame duck period at the end of the year.

THE WEEK AHEAD — Congress has until Friday to avert a partial government shutdown that would impact the FDA and the VA.

The Senate voted 68-13 on Tuesday to advance the stopgap spending measure. House votes Tuesday were canceled due to snow in Washington.

This week on the Hill:

— A House Energy and Commerce subcommittee meets today to tackle the health and safety consequences of the Biden administration’s border policies.

— A group of Senate Democrats, including Senate Majority Leader Chuck Schumer and led by Sen. Patty Murray (D-Wash.), holds a “State of Abortion Rights” event today. “Republicans’ attempts to dodge responsibility for the chaos and trauma they created will not work,” Murray plans to say.

— The Senate Help, Education, Labor and Pensions Committee holds a hearing Thursday on long Covid.

Around the Agencies

APPEAL NO MORE — The Biden administration on Tuesday said it has relinquished its appeal of a ruling that had struck down an HHS rule on cost-sharing in a win for patient advocates.

A 2021 rule permitted payers to exclude drugmaker coupons in calculating patients’ maximum deductibles and out-of-pocket costs, but a federal judge shot it down, prompting the appeal. Patient advocate groups and bipartisan members of Congress led by Reps. Buddy Carter (R-Ga.) and Nanette Diaz Barragán (D-Calif.) had pushed for HHS to end the legal battle.

“We are pleased that the government has withdrawn its appeal of our court victory for patients who struggle to afford their prescription drugs and rely on copay assistance,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, a plaintiff in the lawsuit along with the Diabetes Leadership Council and the Diabetes Patient Advocacy Coalition.

Insurer trade group AHIP had written an amicus brief in the case, pointing the finger at pharmaceutical companies for setting high prices for their drugs and saying that coupons “exacerbate the root causes” of pricey drugs. AHIP and HHS didn’t respond to requests for comments.

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Lobby Watch

FUJIFILM LOBBYING DEVELOPING — Fujifilm Holdings America wants lawmakers to know that it does more than make cameras, Megan reports.

The company is establishing a Washington presence, hiring lobbyists to highlight its biopharmaceutical work as Congress considers ways to help avert drug shortages and increase domestic manufacturing of medicines.

The work is focused on advocacy for Fujifilm Diosynth Biotechnologies, a subsidiary of the company that’s a manufacturing partner to drugmakers. Crystal Fry-Vanuch, who started at the company last year but only recently registered to lobby, will oversee its government affairs and policy operation.

Fujifilm Holdings America has also contracted with Akin Gump Strauss Hauer & Feld, the second-largest lobbying firm in D.C. by revenue, and powerhouse lobby shop CGCN Group.

The plan is to introduce the company to lawmakers and public health officials and its role in the domestic production of pharmaceuticals as the U.S. continues to grapple with supply-chain issues in the pandemic’s wake, said Joe Metzger, vice president of corporate communications at Fujifilm Holdings America.

Akin Gump and CGCN Group declined to comment.

A message from the Coalition to Protect America's Health Care:

Names in the News

Rick Van Buren has joined Cozen O’Connor Public Strategies. He was senior health policy counsel for House Energy and Commerce ranking member Rep. Frank Pallone (D-N.J.).

Beth Leonard has been named chief corporate affairs officer at the Walgreens Boots Alliance, a new role at the company where she will oversee the Walgreens government relations, public affairs and corporate communications teams. Leonard, who joined the company last June, worked at EmblemHealth. Walgreens’ Chuck Greener is retiring after serving 14 years as its global chief public affairs officer. Greener will stay on as a consultant through the end of 2024.

Heide Bajnrauh has joined Manatt, Phelps & Phillips’ health care group as a managing director. She was senior policy adviser at Akin Gump Strauss Hauer & Feld.

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A message from the Coalition to Protect America's Health Care:

Corporate insurance companies are banking record profits —often by delaying and denying Americans’ care. Now the same big insurers are pushing Congress to enact harmful cuts to hospital care.

A majority of American hospitals already operate at a loss. They care for underserved communities, even when patients can’t afford to pay. More than 149 rural hospitals have shuttered or cut services. Hundreds more are at risk of closing.

It’s time to act to protect American patients and the hospitals they count on. Learn more: https://actnow.protecthealthcare.org/a/no-cuts-to-care