March 2024
ISSUE BRIEF
1
HP-2024-08
Health Coverage Under the Affordable Care Act:
Current Enrollment Trends and State Estimates
Based on 2023 and early 2024 enrollment data 45 million people are
currently enrolled in Marketplace or Medicaid expansion coverage under
provisions of the Affordable Care Act (ACA), the highest total on record.
KEY POINTS
• Marketplaces and Medicaid expansion, programs created by the Affordable Care Act (ACA), have
enrolled millions of Americans in participating states since their implementation in 2014.
• According to the most recently available administrative data, we estimate that about 20.5 million
*
consumers were enrolled in Marketplace plans as of February 2024 (across all 50 states and the
District of Columbia), and 18.6 million people (across 39 participating states
†
and the District of
Columbia) were newly enrolled in Medicaid as of September 2023 via the ACA’s expansion of
eligibility to adults.
• In addition, 1.3 million individuals were enrolled in the ACA’s Basic Health Program option in
February 2024, and 4.6 million non-newly eligible adults who were eligible under previous criteria
gained coverage under the Medicaid ACA expansion.
• Across these coverage groups, a total of 45 million Americans were enrolled in coverage related
to the ACA, the highest total on record. This represents 14.1 million more people enrolled than in
2021 (a 46% increase) and 32.5 million more people enrolled than in 2014 (a 258% increase, or
more than triple).
• Marketplace enrollment continues to increase, reaching over 20 million for the 2024 plan year—a
record high since the launch of the ACA Marketplaces a decade earlier.
• This trend has occurred in the context of an overall increase in health insurance coverage in
recent years, including a decline in the uninsured rate—from 16 percent in 2010, prior to ACA
implementation, to 7.7 percent in late 2023 according to the most recent federal survey data.
BACKGROUND
The Affordable Care Act
1
(ACA), which was signed into law in 2010, brought the largest expansion of coverage
in the U.S. health care system since the creation of Medicare and Medicaid in 1965. A comprehensive health
_______________________
*
A total of 21.4 million consumers made plan selections as of January 2024 and an estimated 20.5 million consumers effectuated
enrollment (paid a premium or otherwise completed enrollment) as of February 2024. See notes for Table 1 for more information.
†
North Carolina’s expansion was implemented December 2023.
March 22, 2024
March 2024
ISSUE BRIEF
2
care reform law, the ACA expanded health insurance coverage to millions of Americans through two main
pathways:
• Providing premium tax credits to consumers with incomes between 100% and 400% of the federal
poverty level (FPL) to lower the cost of individual market health insurance purchased through new
state Marketplaces;
‡
and
• Expanding Medicaid eligibility to adults with incomes up to 138% Federal Poverty Level (FPL), in states
that elect to cover these low-income adults.
§
The ACA also provided states the option to implement a Basic Health Program (BHP) to cover low-income
residents who would otherwise be eligible to purchase coverage through the health insurance Marketplaces.
Since implementation of the ACA in 2014, the number of uninsured Americans has fallen significantly. Between
2013 and 2022 the number of people without health insurance dropped by 42 percent, falling from 45.2
million to 26.4 million.
2,3
In recent years, a number of federal policies aimed to support health insurance
coverage have contributed to a steady decline in the uninsured population since 2020.
4
These federal policies
include:
• The Families First Coronavirus Response Act (FFCRA) provided states with additional federal financial
support if they met certain conditions including agreeing to maintain the enrollment of most Medicaid
beneficiaries during a period that began in March 2020 and ended on March 31, 2023.
• CMS has taken extensive regulatory and sub-regulatory actions to implement ACA provisions reducing
coverage loss at Medicaid redetermination, including actions under the Consolidated Appropriations
Act, 2023.
• The American Rescue Plan Act (ARP) of 2021 and the Inflation Reduction Act (IRA) of 2022 increased
Marketplace premium tax credits for individuals and families with household incomes between 100
and 400 percent of the Federal Poverty Level (FPL) and extended eligibility for Marketplace premium
tax credits to those with household income above 400 percent of the FPL.
• Administrative actions extending and establishing special enrollment periods for Marketplace
coverage.
In addition, at the state level, seven states have implemented the ACA Medicaid expansions extending
coverage to low-income adults with incomes up to 138% FPL since 2020 (Utah, Idaho, Nebraska, Oklahoma,
Missouri, South Dakota, and North Carolina). These combined federal and state policies, along with a strong
labor market, have contributed to increased insurance coverage.
During the 2024 Marketplace Open Enrollment Period, over 21.4 million people selected an ACA Health
Insurance Marketplace plan. Total plan selections include more than five million people — about a fourth —
who are new to the Marketplaces and 16 million people who renewed their coverage.
5
Under the enhanced
premium tax credits established under the American Rescue Plan and continued under the Inflation Reduction
Act, four in five HealthCare.gov customers were able to find health care coverage for $10 or less per month for
plan year 2024 after subsidies.
6
_______________________
‡
Individuals with incomes above 400% FPL can purchase coverage through the Marketplaces but did not originally qualify for premium
tax credit subsidies. Under the American Rescue Plan and extended by the Inflation Reduction Act, individuals with incomes above
400% FPL are now potentially eligible for subsidies.
§
The ACA established a minimum Medicaid eligibility level of 133% FPL for children, pregnant women, and adults as of January
2014. States may elect to cover adults with incomes up to 133% FPL in their State Medicaid program, in accordance with the Supreme
Court decision in NFIB v. Sebelius (2012). The low-income adult group also has standard income disregard of five percentage points of
the FPL, which effectively raises this limit to 138% FPL. As of March 2024, 40 states and the District of Columbia have adopted the
Medicaid expansion for low-income adults.
March 2024
ISSUE BRIEF
3
This Issue Brief presents current estimates of enrollment in health insurance coverage obtained through the
ACA Marketplaces and the Medicaid expansion and the subsequent reductions in state-level uninsured rates
since the ACA was implemented in 2014. This issue brief updates our estimates released in March of 2023
where we found that about 40 million people gained coverage under the ACA.
7
METHODS
For both Marketplace and Medicaid expansion enrollment, we present the most recent administrative data
with state-by-state totals from the Centers for Medicare & Medicaid Services (CMS), as well as historical
national totals for the years 2014-2024.
There are two related measures of Marketplace enrollment. The first is plan selections, and the second is
effectuated enrollment. At the end of each annual open enrollment period, CMS releases plan selections,
which are the number of people who have selected a plan; CMS follows later with data on effectuated
enrollment, which captures the number of people who have paid their first month’s premium (if applicable).
In this report, Marketplace enrollment estimates reflect effectuated enrollment counts from both States with
Marketplaces using the HealthCare.gov platform and those with State-based Marketplaces. Effectuated
enrollment for 2024 is not yet available but was estimated from state February 2023 effectuation rates applied
to the number of people selecting Marketplace plans during the 2024 Open Enrollment Period. This brief uses
effectuated enrollment so that our overall coverage estimates can be compared over time using the same
method as ASPE used in previous estimates of ACA-related coverage.
8
Medicaid enrollment estimates are state-reported counts of unduplicated individuals enrolled in the state’s
Medicaid program through the Medicaid Budget and Expenditure System (MBES). The most recent Medicaid
enrollment data are from September 2023. In mid-2023 states began returning to standard renewal
operations with the end of the FFCRA Medicaid continuous enrollment condition. Disenrollments due to this
return to standard renewal operations have led to lower enrollment levels in March 2024 than the September
2023 enrollment data presented. For states that have expanded Medicaid, the enrollment data provide specific
counts of the number of individuals enrolled in the expansion low-income adult eligibility group, referred to as
the “adult group,” with separate totals for those who became newly eligible under the ACA expansion, as well
as those who were eligible for coverage prior to the ACA and meet the criteria for the adult group. State
Medicaid expenditure reports are generally submitted to CMS within 30 days following the end of each
quarter. Some states, however, submit their expenditure reports later; accordingly, these results should be
considered preliminary.
Minnesota and New York have also implemented the Basic Health Program (BHP) option under the ACA to
cover individuals with incomes between 138-200% FPL. We report BHP enrollment as reported to CMS by the
states.
Note that we refer to the estimates below as “2024 estimates” of ACA coverage, though some of the statistics
are from late 2023, since those are the most recently available numbers.
Estimates on uninsured rates by state come from the American Community Survey (ACS), the largest national
survey of households. The Census Bureau surveys almost 300,000 households each month for the ACS and
collects health insurance and demographic data, along with other types of information. Uninsured rates for the
full state population of all ages come from the ACS’s public data tables for 2013 and 2022 (the most current
year of ACS data available), which we used to compare state-by-state changes in uninsured rates since the
implementation of the ACA.
9,10
March 2024
ISSUE BRIEF
4
FINDINGS
National ACA-related enrollment for 2014-2024 are presented in Table 1 and Figure 1. More detailed
information on each source of coverage is described below. As of February 2024, an estimated 20.5 million
consumers had enrolled and effectuated health insurance coverage through the Marketplaces. An estimated
18.6 million newly-eligible adults were enrolled in Medicaid coverage through the adult group created by the
ACA expansion based on the most recently available data, as shown in Table 1. An additional estimated 4.6
million people enrolled in Medicaid are adults who meet the criteria for the ACA expansion group but were
eligible under previous criteria. The ACA simplified Medicaid enrollment for these individuals and made
permanent under federal law some state-specific coverage expansions that pre-dated the ACA (e.g., coverage
under a section 1115 demonstration project). To date, 40 states and the District of Columbia have adopted the
ACA Medicaid expansion of coverage to adults.
Medicaid enrollment increased in recent years due to states implementing the ACA Medicaid expansion and
the continuous enrollment condition in the Families First Coronavirus Response Act of 2020 (FFCRA), which
prevented states from disenrolling most Medicaid enrollees enrolled on or after March 18, 2020 as a condition
for receiving a temporary increase in their federal Medicaid match rate. This condition ended on March 31,
2023 (under the Consolidated Appropriations Act, 2023) and states began returning to normal Medicaid
renewal operations leading to individuals disenrolling from Medicaid (also referenced as Medicaid unwinding),
which is reflected in the 2024 enrollment data.
As noted above, two states – Minnesota and New York – have implemented the BHP option under the ACA. In
early 2024, BHP enrollment was 1.3 million.
Taken together, these results indicate that overall enrollment in Marketplace coverage, Medicaid expansion,
and the Basic Health Program for 2024 was 45 million people, the highest enrollment total since the ACA was
enacted. This represents 14.1 million more people enrolled than in 2021 (a 46% increase) and 32.5 million
more people enrolled than in 2014 (a 258% increase, or more than triple). Since 2023, 4.7 million more people
gained ACA-related coverage, with almost all of the coverage gains from Marketplace.
Table 1
ACA-Related Enrollment: Marketplace, Medicaid, and the Basic Health Program (BHP), 2014-2024
Year
Marketplace
Enrollment*
Medicaid Expansion
Group,
Newly-Eligible#
Medicaid Expansion
Group,
Non-Newly Eligible
BHP
Enrollmentⴕ
TOTAL
ACA-Related
Enrollment
2014 6,337,860 4,214,218 2,047,055 0 12,599,133
2015 10,187,197 9,103,944 3,002,271 358,000 22,651,412
2016 11,115,044 11,135,415 3,473,065 654,000 26,377,524
2017 10,330,759 12,229,576 3,524,856 772,000 26,857,191
2018 10,643,786 12,338,135 3,305,210 798,000 27,085,131
2019 10,579,744 12,201,118 3,247,188 833,000 26,861,050
2020 10,673,516 12,300,921 3,241,535 866,000 27,081,972
2021 11,227,111 14,849,998 3,890,934 961,000 30,929,043
2022 13,807,669 16,781,800 4,261,277 1,135,190 35,985,936
2023 15,661,223 18,765,611 4,648,343 1,243,324 40,318,501
2024 20,524,000** 18,631,914 4,593,306 1,309,358 45,059,000
March 2024
ISSUE BRIEF
5
Notes *
Marketplace effectuated enrollment figures for 2014 and 2015 are as of 12/31/2014 and 3/31/2015 respectively, versus February
coverage as of March 15 for 2016-2021. Marketplace enrollment data for 2014-2015 are lower quality due to the manual payment
processing system in place for those years. 2014 and 2015 Marketplace enrollment figures are published here:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MarketplaceProducts/Effectuated_Quarterly_Snapshots.
February 2016-2023 data are from the CCIIO Enrollment Payment System and beginning in 2017 have been published in the Effectuated Enrollment
Snapshot for the respective year.**Effectuated Marketplace enrollment for 2024 was estimated applying the February 2023 state effectuated rates to
the 21.4 million people who made plan selections during the 2024 Open Enrollment Period,
https://www.cms.gov/marketplace/resources/forms-
reports-other#Health_Insurance_Marketplaces. # Medicaid enrollment data, 2014-2021, are from the February monthly enrollment (ever enrolled
during the month) for the expansion adult eligibility group, as reported by states through the Medicaid Budget and Expenditure System (MBES). 2022-
2024 Medicaid enrollment data are from September 2021, September 2022, September 2023 monthly enrollment reports respectively, as this is the
most recent available monthly enrollment count from MBES. Published reports and detailed data information for Medicaid enrollment data, including
caveats, can be found at: https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/medicaid-chip-enrollment-
data/medicaidenrollment-data-collected-through-mbes/index.html
ⴕ BHP programs did not start until 2015. BHP enrollment data are based on average monthly (for Minnesota) or quarterly (for New
York) projected enrollment submitted by the states to CMS in advance of the applicable quarter and are rounded to the nearest thousand. BHP
enrollment data for 2021 is through May 2021. BHP enrollment data for 2022 is through March 2022. BHP enrollment data for 2023 is through February
2023. BHP enrollment data for 2024 is through February 2024.
Figure 1. ACA-Related Enrollment: Marketplace, Medicaid Expansion,
and the Basic Health Program, 2014-2024
Table 2 presents the most recent state-level enrollment estimates of Marketplace and Medicaid expansion
coverage. Table 3 presents uninsured rates in 2013 (before the ACA) and 2022 (the most recent state-level
uninsured data). Figure 2 provides a visual summary of the change in the uninsured rate in each state.
Nationally, the uninsured rate decreased 6.5 percentage points (from 14.5% to 8.0%) from 2014 to 2022. All
states experienced reductions in their uninsured rates, with 12 states – California, Indiana, Kentucky,
Louisiana, Michigan, New Hampshire, New Mexico, New York, Oregon, Rhode Island, Washington, and West
March 2024
ISSUE BRIEF
6
Virginia, and the District of Columbia, all of which expanded Medicaid – reducing their uninsured rate by at
least half. The uninsured rate in 2022 varied widely across the country. Massachusetts had the lowest
uninsured rate at 2.4% and experienced one of the smaller relative reductions under the ACA because it had
already implemented large coverage expansions prior to 2014. Texas, which has not expanded Medicaid, had
the highest uninsured rate in both 2013 (22.1%) and 2022 (16.6%). State decisions regarding the ACA Medicaid
expansion are a main driver of variability in coverage rates across states. The Census Bureau’s gold-standard
estimates of the uninsured population, which come from the ACS, are not yet available for 2023.
Table 2: Marketplace Enrollment and Medicaid Expansion Enrollment by State
State
Marketplace Marketplace Medicaid Expansion Medicaid Expansion Total
Plan Selections Effectuated Enrollment Newly Eligible Non-Newly Eligible ACA-Related
January 2024* February 2024+ September 2023# September 2023# Coverage
Alabama
386,195
369,000
N/A
N/A
369,000
Alaska
27,464
26,000
68,692
N/A
94,692
Arizona
348,055
330,000
129,676
523,245
982,921
Arkansas
156,607
143,000
244,108
9,146
396,254
California
1,784,653
1,736,000
5,151,950
29,935
6,917,885
Colorado
237,106
212,000
544,038
7,667
763,705
Connecticut
129,000
125,000
334,664
31,308
490,972
Delaware
44,842
43,000
14,652
80,957
138,609
District of Columbia
14,799
12,000
87,379
43,975
143,354
Florida
4,211,902
4,060,000
N/A
N/A
4,060,000
Georgia
1,305,114
1,250,000
N/A
N/A
1,250,000
Hawaii
22,170
21,000
28,000
143,705
192,705
Idaho
103,783
101,000
83,833
0
184,833
Illinois
398,814
362,000
916,458
81,457
1,359,915
Indiana
295,772
282,000
581,737
0
863,737
Iowa
111,423
108,000
186,569
22,521
317,090
Kansas
171,376
163,000
N/A
N/A
163,000
Kentucky
75,317
68,000
593,558
0
661,558
Louisiana
212,493
207,000
737,762
0
944,762
Maine
62,586
60,000
91,408
23,886
175,294
Maryland
213,895
202,000
455,948
0
657,948
Massachusetts
311,199
277,000
0
463,523
740,523
Michigan
418,100
399,000
975,567
60,833
1,435,400
Minnesota
1
135,001
130,000
307,001
0
522,496
Mississippi
286,410
272,000
N/A
N/A
272,000
Missouri
359,369
345,000
343,168
0
688,168
Montana
66,336
64,000
94,731
0
158,731
Nebraska
117,882
111,000
80,692
1,898
193,590
Nevada
99,312
96,000
374,633
0
470,633
New Hampshire
65,117
63,000
60,642
425
124,067
New Jersey
397,942
386,000
736,843
0
1,122,843
New Mexico
56,472
61,000
268,125
0
329,125
New York
1
288,681
270,000
417,302
2,078,789
3,989,954
North Carolina
1,027,930
987,000
N/A
N/A
987,000
North Dakota
38,535
37,000
29,964
1,501
68,465
Ohio
477,793
463,000
901,967
238
1,365,205
Oklahoma
277,436
265,000
303,033
0
568,033
Oregon
145,509
137,000
608,684
111,016
856,700
Pennsylvania
434,571
422,000
1,024,336
61,267
1,507,603
March 2024
ISSUE BRIEF
7
Table 2: Marketplace Enrollment and Medicaid Expansion Enrollment by State, (cont’d)
State
Marketplace Marketplace Medicaid Expansion Medicaid Expansion Total
Plan Selections
Effectuated
Enrollment
Newly Eligible Previously Eligible ACA-Related
January 2024* February 2024+ September 2023# September 2023# Coverage
Rhode Island 36,121 36,000 97,376 N/A 133,376
South Carolina 571,175 566,000 N/A 0 566,000
South Dakota 52,974 51,000 10,164 N/A 61,164
Tennessee 555,103 529,000 N/A N/A 529,000
Texas 3,484,632 3,300,000 N/A N/A 3,300,000
Utah 366,939 357,000 111,402 998 469,400
Vermont 30,027 29,000 0 79,221 108,221
Virginia 400,058 385,000 739,411 0 1,124,411
Washington 272,494 263,000 688,514 19,949 971,463
West Virginia 51,046 48,000 207,927 0 255,927
Wisconsin 266,327 257,000 N/A N/A 257,000
Wyoming 42,293 41,000 N/A N/A 41,000
Guam N/A N/A N/A 6,188 6,188
Puerto Rico N/A N/A N/A 695,102 695,102
Virgin Islands N/A N/A N/A 14,556 14,556
Total 21,446,150 20,524,000 18,631,914 4,593,306 45,059,000
Notes:
* 2024 plan selections from states with HealthCare.gov Marketplaces for the Open Enrollment Period of November
1, 2023 to January 16, 2024. Dates through which data are reported vary for State Based Marketplaces.
https://www.cms.gov/marketplace/resources/forms-reports-other#Health_Insurance_Marketplaces.
State totals do not add up due to rounding.
+
Effectuated Marketplace enrollment for 2024 was estimated applying
the February 2023 state effectuated rates to the 21.4 million people who signed-up for coverage during the 2024
Open Enrollment Period, https://www.cms.gov/marketplace/resources/forms-reports-
other#Health_Insurance_Marketplaces. # Medicaid Data: September 2023 enrollment of newly eligible population
as reported on the CMS-64. Awaiting state reporting, enrollment reasonableness review is in progress. Enrollment
only applicable for states that have expanded their Medicaid programs to adults with incomes up to 138% FPL (the
“adult group”). For the states that have not expanded Medicaid their enrollment is noted as “N/A.” Massachusetts
and Vermont already offered subsidized coverage to those with incomes below 138% FPL, so they are listed as
having 0 newly-eligible adults, even though they have implemented the ACA’s Medicaid expansion.
1
Minnesota total includes an estimated 85,495 Basic Health Plan enrollees as of February 2024.
2
New York total includes an estimated 1,223,863 Basic Health Plan enrollees as of February 2024.
March 2024
ISSUE BRIEF
8
Table 3: Uninsured Rates for 2013 and 2022
State
Uninsured Rate %^
2013 2022
Alabama
13.6
8.8
Alaska
18.5
11.0
Arizona
17.1
10.3
Arkansas
16.0
10.1
California
17.2
6.5
Colorado
14.1
7.1
Connecticut
9.4
5.2
Delaware
9.1
5.6
District of Columbia
6.7
2.9
Florida
20.0
11.2
Georgia
18.8
11.7
Hawaii
6.7
3.5
Idaho
16.2
8.2
Illinois
12.7
6.6
Indiana
14.0
7.0
Iowa
8.1
4.5
Kansas
12.3
8.6
Kentucky
14.3
5.6
Louisiana
16.6
6.9
Maine
11.2
6.6
Maryland
10.2
6.1
Massachusetts
3.7
2.4
Michigan
11.0
4.5
Minnesota
8.2
4.5
Mississippi
17.1
10.8
Missouri
13.0
8.6
Montana
16.5
8.3
Nebraska
11.3
6.7
Nevada
20.7
11.1
New Hampshire
10.7
4.9
New Jersey
13.2
6.8
New Mexico
18.6
8.2
New York
10.7
4.9
North Carolina
15.6
9.3
North Dakota 10.4 6.4
Ohio
11.0
5.9
Oklahoma
17.7
11.7
Oregon
14.7
6.0
Pennsylvania
9.7
5.3
Rhode Island
11.6
4.2
South Carolina
15.8
9.1
South Dakota
11.3
8.1
Tennessee
13.9
9.3
Texas
22.1
16.6
Utah
14.0
8.1
Vermont
7.2
3.9
Virginia
12.3
6.5
Washington
14.0
6.1
West Virginia
14.0
5.9
March 2024
ISSUE BRIEF
9
Table 3: Uninsured Rates for 2013 and 2022 (cont’d)
State
Uninsured Rate %^
2013 2022
Wisconsin 9.1 5.2
Wyoming 13.4 11.5
Total 14.5 8.0
^
Uninsured Rates: American Community Survey, “Health Insurance Coverage Status and Type of Coverage by State
and Age for All People”, 2013-2022: https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-
hi.2013.html.
Figure 2: Relative Reduction in the Uninsured Rate by State, 2013 to 2022
Uninsured Rates: American Community Survey, “Health Insurance Coverage Status and Type of Coverage by State
and Age for All People”, 2013-2022: https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-
hi.2013.html.
March 2024
ISSUE BRIEF
10
CONCLUSION
The ACA’s multiple programs have led to an historic expansion of health coverage, with an estimated 45
million people currently enrolled in coverage related to the law. Gains have accelerated since 2021,
concurrent with legislative and administrative efforts to expand health coverage. These efforts include:
enhanced subsidies for Marketplace coverage under the American Rescue Plan and later extended by the
Inflation Reduction Act; robust outreach efforts to sign up eligible individuals for coverage; special enrollment
periods for COVID, consumers with household incomes at or below 150 percent of the Federal Poverty Level
and those disenrolled from Medicaid due to the end of the continuous enrollment condition that had been in
place during the COVID-19 public health emergency; and state adoption of ACA Medicaid expansions.
Of note, estimates of ACA-related coverage presented in this Issue Brief are a conservative estimate of the
law’s impact on health insurance coverage for several reasons. First, the effectuated enrollment estimate for
the Marketplace is a more conservative estimate than plan selections. Second, the total does not include the
provision of the ACA that took effect in 2010 allowing young adults to remain on their parents’ plans (e.g.,
employer sponsored insurance) until age 26, which previous research estimated led to more than 2 million
young adults gaining insurance within the first year that it was in effect .
11
Third, the streamlining of Medicaid
applications, enhanced outreach, and expanded eligibility led to increased enrollment even among children
and parents who were eligible for Medicaid through traditional pre-expansion pathways, a phenomenon
referred to as the “welcome mat” effect.
12
Thus, 45 million likely underestimates the total effect of the ACA.
March 2023
ISSUE BRIEF
11
REFERENCES
1
As amended by the Health Care and Education Reconciliation Act of 2010.
2
Census Bureau, American Community Survey Tables for Health Insurance Coverage Status and Type of Coverage by State
and Age for All People. Accessed at: https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-
hi.2013.html.
3
Census Bureau, American Community Survey Tables for Health Insurance Coverage Status and Type of Coverage by State
and Age for All People. Accessed at https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-
hi.2022.html#list-tab-776654388
4
National Uninsured Rate Remains Largely Unchanged at 7.7 Percent in the Third Quarter of 2023. (Issue Brief No. HP-
202402). Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.
February 2024. Accessed at: https://www.aspe.hhs.gov/reports/national-uninsured-rate-q3-2023
5
Health Insurance Marketplaces 2024 Open Enrollment Report. CMS. March 2024. Accessed at:
https://www.cms.gov/marketplace/resources/forms-reports-other#Health_Insurance_Marketplaces
6
Health Insurance Marketplaces 2024 Open Enrollment Report. CMS. March 2024. Accessed at:
https://www.cms.gov/marketplace/resources/forms-reports-other#Health_Insurance_Marketplaces
7
Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates. Office of the Assistant
Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. March 2023. Accessed at:
https://aspe.hhs.gov/reports/current-health-coverage-under-affordable-care-act.
8
Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates. Office of the Assistant Secretary
for Planning and Evaluation, U.S. Department of Health and Human Services. March 2023. Accessed at:
https://aspe.hhs.gov/reports/current-health-coverage-under-affordable-care-act
Lee A, Chu RC, Peters C, and Sommers BD. Health Coverage Changes Under the Affordable Care Act: End of 2021 Update.
(Issue Brief No. HP-2022-17). Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and
Human Services. April 2022. Accessed at: https://aspe.hhs.gov/reports/health-coverage-changes-2021-update
9
Census Bureau, American Community Survey, Health Insurance Coverage Status and Type of Coverage by State and Age
for All People. Accessed at: https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-hi.2013.html.
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Lee A, Ruhter J, Bosworth A, Peters C, De Lew N, Sommers BD. Changes in Health Insurance Coverage from 2019 to
2021: Geographic and Demographic Patterns in the Uninsured Rate (Issue Brief No. HP-2023-01). Office of the Assistant
Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. January 2023. Accessed at:
https://aspe.hhs.gov/reports/changes-health-insurance-coverage-2019-2021.
11
Uberoi, N., Finegold, K., & Gee, E. (March 3, 2016). Health insurance coverage and the Affordable Care Act, 2010-2016.
Washington (DC): Department of Health and Human Services, Office of the Assistant Secretary for Planning and
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Hudson, J. and Moriya, A. “Medicaid Expansion for Adults Had Measurable ‘Welcome Mat’ Effects on their Children”.
Health Affairs, September 2017.
HP-2024-08
March 2023
ISSUE BRIEF
12
HP-2024-8
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Assistant Secretary for Planning and Evaluation
200 Independence Avenue SW, Mailstop 447D
Washington, D.C. 20201
For more ASPE briefs and other publications, visit:
aspe.hhs.gov/reports
SUGGESTED CITATION
Health Coverage Under the Affordable Care Act:
Current Enrollment Trends and State Estimates. Office of the
Assistant Secretary for Planning and Evaluation, U.S. Department
of Health and Human Services. (Issue Brief No. HP-2024-8).
March 2024. Accessed at: https://aspe.hhs.gov/reports/aca-
related-enrollment-february-2024
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