📣 Today is the 15th Anniversary of the Patient Protection & Affordable Care Act, aka the #ACA. CMS usually posts the official Open Enrollment Period enrollment report on or around the ACA's anniversary. This year I don't expect that, so here's the unofficial tally: acasignups.net/25/02/10/boo...

BOOM: ACA Open Enrollment hits...
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As of February 2025, ~26 million Americans are enrolled in #ACA exchange Qualified Health Plans or Basic Health Plans nationally. That's 7.6% of the total U.S. population. acasignups.net/25/01/24/twe...
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AS of June 2024, ~20 million Americans were enrolled in Medicaid thanks to #ACA expansion across 40 states +DC. That's 5.9% of the total U.S. population. This is down somewhat from an all-time high of nearly 24M during the COVID pandemic. acasignups.net/25/01/24/twe...
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Combined (and with off-exchange ACA QHPs added in), that's over 47 million Americans who receive healthcare coverage specifically via the #ACA (the blue labels in the Psychedelic Donut® below). That's nearly 14% of the total U.S. population. acasignups.net/25/01/30/psy...
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Unfortunately, both the #ACA's exchange plans as well as its Medicaid expansion programs are under direct threat by Trump & MAGA Republicans. Much has been said about Medicaid. Less has been said re. ACA exchange plans, where the main threat is that Republicans will do NOTHING AT ALL. To explain:
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The ACA's original premium subsidy formula was never generous enough--it was decent for very low income enrollees (under 200% of the federal poverty level), but stingy for the next income tier (200 - 400% FPL), and cut off *completely* for anyone earning more than 400% FPL.
That's around $62K/yr if you're single, or ~$128K/yr for a family of four. If you made even $1 over the 400% cut-off, you'd lose eligibility for ANY financial help at all. In 2021, Democrats & President Biden fixed this via the ARPA...but only for 2 years. The IRA fixed it for another 3.
They fixed it by a) making the ACA premium subsidies far more genrous for those under 400% FPL, and b) by removing the 400% FPL cut-off. This means that the subsidies still taper off on a sliding scale, but they do so more gradually. Here's an example of the change from Henrico County, VA:
Unfortunately, the ACA subsidy upgrade is currently scheduled to expire at the end of THIS YEAR. If Congress takes no action to extend it, that means premiums will skyrocket for over 20 million Americans starting in January 2026.
Here's some examples in Michigan, assuming the benchmark Silver plan: --A single 50-yr old would see their net premiums TRIPLE --A single parent earning $30K/yr would go from $0 to paying $87/mo. --A 64-yr old couple earning $90K/yr would pay $20,000 MORE per year. acasignups.net/24/12/29/how...
How much more will MICHIGAN residents pay if the improved #ACA subsidies aren't extended?

It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier. In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies. Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula: Unfortunately, the ARPA's subsidy enhancements included a major caveat: They were only in place for three years, originally scheduled to terminate effective December 31, 2023 (they were retroactive to the beginning of 2021). The good news is that this sunset date was bumped out by another two years as part of the Inflation Reduction Act (IRA) passed in 2022.

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Believe it or not, Michigan is only in the MIDRANGE of how ugly things would get. Minnesota is the least-dramatic case: Premiums would "only" increase by up to 90% for a single adult, while the 64-yr old couple would "only" have to pay up to 2.3x as much. acasignups.net/24/12/03/sta...

State by State: How much more ...
State by State: How much more will MINNESOTA residents pay if the enhanced ACA subsidies aren't extended?

It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier. In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies. Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula: Unfortunately, the ARPA's subsidy enhancements included a major caveat: They were only in place for three years, originally scheduled to terminate effective December 31, 2023 (they were retroactive to the beginning of 2021). The good news is that this sunset date was bumped out by another two years as part of the Inflation Reduction Act (IRA) passed in 2022.

ACA Signups
At the opposite end of the scale is ALASKA. The Federal Poverty Level is 25% higher in AK than the rest of the country, which means that 400% FPL cut-off is higher as well. Even so, the impact of IRA subsidies expiring would be DEVASTATING. See the next post. acasignups.net/25/02/05/hol...

Hold Onto Your Hats: How much ...
Hold Onto Your Hats: How much more will ALASKA residents pay if the improved #ACA subsidies aren't extended?

It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier. In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies. Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula: Unfortunately, the ARPA's subsidy enhancements included a major caveat: They were only in place for three years, originally scheduled to terminate effective December 31, 2023 (they were retroactive to the beginning of 2021). The good news is that this sunset date was bumped out by another three years as part of the Inflation Reduction Act (IRA) passed in 2022.

ACA Signups
I had to extend the graphic to fit Alaska. Yeah, that's right: A 64-yr old couple earning $110K/yr would go from paying $828/mo in prmeiums for the benchmark plan...to over $5,100/month. That's over $61,000/yr in premiums. That's not a typo.
P.S. For what it's worth, here's the ACA's public approval rating. As @christinasho.bsky.social noted, the ACA's approval pulled ahead and never looked back starting in early 2017...aka the exact moment that Republicans tried in earnest to actually repeal it. bsky.app/profile/larr...

RE: https://bsky.app/profile/did:plc:smmj6cow4m6wgtqgypsrhwbq/post/3ll2i34btxk2k
Christina S. Ho (@christinasho.bsky.social)

law professor, former House and Senate staffer, ex Clinton White House, etc. Health policy and ballet are both embodiment practices. Book: https://tinyurl.com/Normalizing-Right-to-Health

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